Evaluating a Large-Scale Multi-Center Outreach Program for Appointment Booking and Patient Engagement: A Quality Improvement Study

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