Abstract
Introduction Missed appointments (no-shows) and lapses in follow-up care are common challenges in healthcare, adversely affecting outcomes and efficiency. This study evaluated a system-wide quality improvement initiative implementing a centralized outbound call program aimed at improving appointment scheduling and continuity of care across a tertiary hospital and its satellite clinics. Methods The intervention (May to November 2025) consisted of a centralized call-center team that conducted 548,089 outbound calls to patients for three campaign types: (1) administrative recovery (rescheduling missed/canceled visits), (2) continuity of care (post-visit, emergency department, or post-discharge follow-ups), and (3) preventive/safety outreach (e.g., preventive screenings, abnormal result follow-ups). Callers used standard scripts and attempted up to three calls per patient as needed. Outcomes were analyzed retrospectively at the call-attempt level. The primary outcome was successful appointment booking (new appointment scheduled during/immediately after the call). The secondary outcome was patient engagement, defined as either a booked appointment or confirmation that an appropriate follow-up was already in place. Key outcomes were compared between the main hospital and satellite clinics using chi-square tests. The study was classified as a quality improvement activity and exempt from IRB review. Results Out of 548,089 call attempts, 66,238 new appointments were booked (12.1% of all calls). After excluding wrong numbers, calls about deceased patients, and calls to patients who already had an upcoming appointment, the adjusted booking rate was 14.6%. An additional 90,774 calls (16.6%) confirmed that patients already had a scheduled follow-up. Combining these, about 28.6% of all calls resulted in verified engagement with care (either new or pre-existing). Conversely, 42.9% of calls reached patients who declined scheduling, and 25.7% of calls did not reach the patient (no answer or voicemail). Booking outcomes were similar at the main hospital (12.3%) and clinics (11.4%, p<0.001), but overall engagement was higher for hospital calls (31.0% vs. 20.7%, p<0.001) due to more patients already having follow-ups. Campaign-level results varied: preventive screening calls yielded low booking rates (e.g., ~5% for mammography outreach) with many declines, whereas follow-up on abnormal results achieved higher booking rates (~26%) and often found existing appointments. A chi-square test confirmed significant heterogeneity in engagement across campaign types (p<0.001). No intervention-related adverse events were identified. Conclusion Implementing a centralized outreach program across multiple centers was associated with improved appointment connectivity, scheduling over 66,000 appointments and verifying care plans for an additional 90,000 patients within seven months. The initiative's impact varied by context-patients from the main hospital were often already in care, while those from satellite clinics benefited more from new scheduling. These findings underscore the importance of tailoring outreach strategies to patient needs and clinical context. The program demonstrates a feasible, scalable approach to reducing no-shows and enhancing continuity of care. Future efforts should focus on increasing patient contact rates (e.g., via multimodal communication), understanding reasons for declined outreach, and assessing downstream clinical outcomes.