Designing risk prediction models for ambulatory no-shows across different specialties and clinics.


Objective:As available data increases, so does the opportunity to develop risk scores on more refined patient populations. In this paper we assessed the ability to derive a risk score for a patient no-showing to a clinic visit. Methods:Using data from 2 264 235 outpatient appointments we assessed the performance of models built across 14 different specialties and 55 clinics. We used regularized logistic regression models to fit and assess models built on the health system, specialty, and clinic levels. We evaluated fits based on their discrimination and calibration. Results:Overall, the results suggest that a relatively robust risk score for patient no-shows could be derived with an average C-statistic of 0.83 across clinic level models and strong calibration. Moreover, the clinic specific models, even with lower training set sizes, often performed better than the more general models. Examination of the individual models showed that risk factors had different degrees of predictability across the different specialties. Implementation of optimal modeling strategies would lead to capturing an additional 4819 no-shows per-year. Conclusion:Overall, this work highlights both the opportunity for and the importance of leveraging the available electronic health record data to develop more refined risk models.





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Publication Info

Ding, Xiruo, Ziad F Gellad, Chad Mather, Pamela Barth, Eric G Poon, Mark Newman and Benjamin A Goldstein (2018). Designing risk prediction models for ambulatory no-shows across different specialties and clinics. Journal of the American Medical Informatics Association : JAMIA, 25(8). pp. 924–930. 10.1093/jamia/ocy002 Retrieved from

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Ziad F. Gellad

Professor of Medicine

Dr. Gellad is an associate professor of medicine in the Division of Gastroenterology at Duke University Medical Center and the Chief of Gastroenterology at the Durham VA Health Care System.  His research focuses on quality of care in gastroenterology, with a particular focus on colorectal cancer screening. Dr. Gellad has also received several innovation grants to develop and implement novel information technology platforms to improve the patient and clinician experience.  He is also an active contributor to the innovation and entrepreneurship activities within Duke University and co-founder of a health technology startup in Durham, NC.

Dr. Gellad received his MD and MPH degrees from Johns Hopkins University.  He completed a residency in internal medicine and a fellowship in gastroenterology at Duke University Medical Center.   Dr. Gellad is past-chair of the Quality Measures Committee of the American Gastroenterological Association, associate editor for GI & Hepatology News and is on the Board of Editors for Clinical Gastroenterology and Hepatology.


Eric Gon-Chee Poon

Professor of Medicine

I currently serve as the Chief Health Information Officer for Duke Medicine. I also practice primary care internal medicine at the Durham Medical Center as part of Duke Primary Care. In my capacity as CHIO, I am responsible for the visioning and strategic planning of clinical and analytic information systems that impact patient care, research and education.  I work with the Duke Medicine leadership to ensure technology solutions are well aligned with our overall organizational objectives. I oversee the optimization of the Maestro Care (Epic) electronic health record, and partner with physicians, patients and operational leaders to effectively leverage innovative IT in support of the Duke mission.  I also have a keen interest in IT innovation, and work with investigators across Duke to pursue new and innovative ways to efficiently deliver high quality care to our patients.

My research interests have revolved around the use of health information technology to improve the quality of care and patient safety in both the ambulatory and hospital settings.  My work in the ambulatory setting has focused on the efficient delivery of decision support to clinicians to prevent errors of omission and commission during diagnostic test ordering and review of test results. I have also worked to use information technology, including secure on-line patient portals, to improve the communication between clinicians and patients around health maintenance and the follow-up of abnormal test results.  In the inpatient setting, I have conducted several studies to delineate the barriers to and facilitators of the wide-spread diffusion of computerized physician order entry and have led many studies evaluating the safety, financial and socio-technical impact of barcode technology in the hospital pharmacy and nursing units. 


Mark Franklin Newman

Merel H. Harmel Distinguished Professor Emeritus of Anesthesiology

Best known for his work in assessing and improving clinical outcomes and quality of life following cardiac surgery, Dr. Mark Newman is President of the Duke Private Diagnostic Clinic (The Duke Faculty Practice Organization) and the Merel H. Harmel Professor of Anesthesiology at Duke University Medical Center. In addition, Dr. Newman developed the Multicenter Perioperative Outcomes Research Group of the Duke Clinical Research Institute established at Duke in 2001 to further the study of strategies to improve the outcomes of patients undergoing surgery and anesthesia. Dr. Newman has received funding from the National Institute on Aging, the American Heart Association, the National Heart, Lung and Blood Institute, the Anesthesia Patient Safety Foundation, and the International Anesthesia Research Society  to investigate the impact of perioperative outcomes (neurocognitive decline, stroke, myocardial infarction, renal injury) on quantity and quality of life following cardiac surgery and resulting in numerous seminal publications in the New England Journal of Medicine, JAMA and Lancet. Dr. Newman is a popular lecturer and speaker, having appeared on NBC Nightly News and The Today Show and having spoken at more than 200 national and international meetings.  Dr. Newman recently stepped down as the Chairman of the Duke University Department after 13 years to assume the role of PDC President.  During Dr. Newman’s tenure the department grew exponentially doubling its clinical and academic funding, and developing many outstanding individuals that have gone on to leadership roles at Duke and other key academic institutions across the country.


Benjamin Alan Goldstein

Professor of Biostatistics & Bioinformatics

I study the meaningful use of Electronic Health Records data. My research interests sit at the intersection of biostatistics, biomedical informatics, machine learning and epidemiology. I collaborate with researchers both locally at Duke as well as nationally. I am interested in speaking with any students, methodologistis or collaborators interested in EHR data.

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