Improving Rates of Cardiac Stress Test Completion through Scheduling Interventions

OBJECTIVES: This study aimed to evaluate the impact of a multi-layered intervention on improving rates of cardiac stress test scheduling and completion by reducing barriers to scheduling. METHODS: Using a nonrandomized mixed-methods pre-post design, we identified patients for whom a stress test was ordered in primary care but had not been scheduled within 4 weeks. The first intervention consisted of proactive outreach phone calls by a primary care patient service representative for test scheduling. The second intervention consisted of priming phone calls to patients, which served as a reminder to schedule their appointment and an invitation to participate in a brief, semi-structured interview to understand barriers to test scheduling. Changes in scheduling rates and completion rates were analyzed using hypothesis tests, and time to completion was analyzed using X-bar/S charts. RESULTS: Compared with the baseline cohort (n = 157), patients in the intervention cohort (n = 548) completed their stress tests at a significantly higher rate (66.2% [104] baseline; 81.0% [444] intervention; p = .00008). Patients in the intervention cohort similarly scheduled their tests at an improved rate (70.1% [110] baseline; 91.2% [500] intervention). Time to test completion was also significantly reduced in the intervention group (44.70 days [σ = 72.93] baseline; 33.6 days [σ = 26.67] intervention). Interviews revealed that patients had trouble scheduling their tests due to a lack of time and confusing processes. CONCLUSIONS: A multi-layered outreach intervention was successful in improving the rates of completion and scheduling for cardiac stress tests, as well as reducing time to completion. The pilot was found to be cost-effective, but may increase workload for primary care staff. Future studies should investigate ways to automate processes to reduce the burden on the system. Our study describes a potentially quality-improving intervention by introducing a new scheduling process, which is not the existing standard of care.