Effect of open access scheduling on missed appointments, immunizations, and continuity of care for infant well-child care visits

Objective: To examine the effect of open access scheduling (OA) on infant well-child care (WCC). Design: Cluster randomization of 2 methods of OA compared with a baseline group (prior to OA). Setting: Community health center pediatric clinic, August 1, 2003, to January 31, 2004. Participants: Ten providers (pediatricians and physician assistants) and 878 infants; 2-,4-, and 6-month WCC visits were scheduled. Interventions: Two scheduling methods were compared under the OA model: the OA future visit group scheduled their infant's next WCC visit when leaving the visit, and the OA same day group called for a same-day appointment. Main Outcome Measures: Missed appointment rates, on-time immunization rates, and continuity of care. Results: Missed appointment rates decreased from 21% in the baseline group to 14% and 9% in the OA future visit and OA same day groups, respectively (P <.02). For 630 infants older than 5 months at study end, on-time immunization rates were 59% in the baseline group and 74% in both OA groups (P <.006). Of 412 infants with 2 or more WCC visits, 75% in the OA future visit group and 60% in the OA same day group saw the same provider for all visits (P=.001). This difference was due to differences among providers, not to the different scheduling methods. Conclusion: Open access scheduling decreases missed appointments for infant WCC visits and appears to increase on-time immunizations.