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Automated IVR calls added to SMS reminders reduce missed appointments among high-risk patients

Adding automated interactive voice response (IVR) calls to existing text message reminders reduced no-show rates by 1.7 percentage points (from 11.3% to 9.6%) and increased appointment completion rates by 1.9 percentage points (from 75.9% to 77.8%) among high-risk patients. The intervention had the greatest effect on reducing no-shows in the highest risk quartile and improved equity by increasing completion rates most among Black patients.

Last updated: Jul 11, 2026•1 RCTs•📖 Read as article →

Evidence Score

Evidence Score44/100
Human RCT★★☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Automated Calls Added to SMS Reminders Reduce Missed Appointments among High-Risk Patients.

observational

Kavanaugh L, Thomas S, Lynch S, Leri D, Xiong RA, Xu L, Snider CK, Ebert JP, Harhay MO, Lu Y, Orwig N, Desir N, Encarnacion IN, Mollanazar N, Thomas R, Bae C, Gitelman Y, Hahn L, Lee K, Mehta SJ, Merchant RM, Delgado MK · NEJM catalyst innovations in care delivery (2026)

Participants: N/A
Duration: 4 weeks
Intervention: Automated IVR call in addition to standard text message appointment reminders
Outcome: No-show rate, appointment completion rate
Effect Size: 1.7 percentage point reduction in no-show rate; 1.9 percentage point increase in appointment completion rate
Population: 59,994 patients at high risk of missing their appointment (identified by EHR predictive model) at Penn Medicine

Result:

PubMed: 42418615DOI: 10.1056/CAT.25.0322

Mechanism Graph

Predictive model identifies high-risk patients
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Automated IVR call placed before appointment
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Patient confirms, cancels, or reschedules via voice response
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Result: Reduced no-shows and increased completed appointments

Limitations

  • ⚠Single health system (Penn Medicine) limits generalizability
  • ⚠Short trial duration (4 weeks) may not capture seasonal or long-term variability

Frequently Asked Questions

How much did the IVR intervention reduce no-show rates?▼

The no-show rate dropped by 1.7 percentage points, from 11.3% to 9.6%.

Which patient group benefited most from the IVR calls?▼

Patients in the highest risk quartile had the greatest reduction in no-shows, and Black patients had the largest increase in appointment completion rates.

Was the intervention sustained after the trial?▼

Yes, follow-up data from over 244,000 high-risk patients over 6 months showed sustained improvement in appointment completion rates.

How many additional appointments could be completed per million slots?▼

The results imply that 19,000 additional appointments could be completed per million new appointment slots.

Products

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References

  1. 1.Kavanaugh L, Thomas S, Lynch S, Leri D, Xiong RA, Xu L, Snider CK, Ebert JP, Harhay MO, Lu Y, Orwig N, Desir N, Encarnacion IN, Mollanazar N, Thomas R, Bae C, Gitelman Y, Hahn L, Lee K, Mehta SJ, Merchant RM, Delgado MK. "Automated Calls Added to SMS Reminders Reduce Missed Appointments among High-Risk Patients.." NEJM catalyst innovations in care delivery, 2026. PMID: 42418615 DOI: 10.1056/CAT.25.0322
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.