An appointment-keeping improvement package for outpatient pediatrics: systematic replication and component analysis.
A mailed reminder plus parking pass makes more people cancel early but does not raise actual clinic attendance.
01Research in Context
What this study did
The team mailed families a reminder plus a free parking pass. They wanted more kids to show up for outpatient visits.
They compared the combo against a no-mail control. They also tracked how many people cancelled ahead of time.
What they found
More families called to cancel when they got the letter and pass. But the number who actually showed up stayed the same.
The authors think the gap between booking and the visit was still too long. A short lag may matter more than free parking.
How this fits with other research
Davison et al. (1984) got better turnout by cutting the co-pay. Money in the patient’s pocket beat a free parking pass.
Peskin et al. (2025) later tried a public survey link. Like V et al., it raised form returns yet failed to lift final attendance.
Omino et al. (1993) ran a similar strip-down test on child treatment parts. Both 1993 papers show that peeling apart a package can reveal what truly drives change.
Why it matters
If you want families to walk through the door, sweeten the visit itself, not the drive there. Try a same-week slot or a small fee discount. Skip the mailed perks that only prompt polite cancellations.
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02At a glance
03Original abstract
Child health-care appointments that are not kept are an important pediatric problem. Previous research has shown that reducing effort (with a parking pass) and reminding patients (with mailed and telephone reminders) significantly improved appointment keeping for first-time and patient-scheduled appointments. This study, using a posttest-only group design, evaluated the effects of various combinations of that intervention applied to clinic-scheduled follow-up appointments. All combinations of the intervention significantly increased cancellations, but none increased appointments kept or decreased appointments not kept significantly. Log linear analyses showed that the lag time between scheduling and the appointment significantly influenced appointment keeping. The results suggest that if clinics want to increase cancellations, a mailed reminder and effort reduction are sufficient. To increase appointment keeping, other interventions, such as reduced lag time, may be necessary.
Journal of applied behavior analysis, 1993 · doi:10.1901/jaba.1993.26-461