Public Health in the Rockies 2026

Background:

As part of Colorado's largest safety-net hospital system, the Infectious Disease Clinic at Denver Health provides primary care for patients living with HIV and follow-up care for other serious infections. The clinic experiences a 20% no-show rate for appointment outcomes, defined by an unanticipated patient absence from a scheduled appointment. Missed appointments disrupt care continuity and clinic efficiency. This analysis evaluated demographic, appointment, and access-related characteristics associated with no-show outcomes to ensure standard reminder procedures meet the diverse needs of the patient population.

Methods:

We examined 22,904 scheduled appointments for 3,253 patients seen at the Infectious Disease clinic between January 2024 and June 2025. We used multivariable log binomial regression, clustered by patient, to assess the associations between age, race/ethnicity, prior no-show history, appointment lead time, time of day, day of week, insurance type, and distance to clinic with a no-show outcome.

Results:

When evaluating these characteristics, we found that younger patients (17–25 years) had the highest risk of a no-show outcome compared to those aged ≥66 years [adjusted risk ratio (aRR)=2.34, 95% confidence interval (CI): 1.86–2.93]. Hispanic and Black, non-Hispanic patients had higher risk than White, non-Hispanic patients (Hispanic aRR=1.33, CI: 1.20–1.48; and Black, non-Hispanic aRR=1.35, CI: 1.19–1.53). Patients with Medicare/Medicaid/financial assistance had a higher risk of a no-show outcome compared to commercial insurance holders (aRR=1.82, CI: 1.66–1.99). Prior no-show outcomes within 365 days (aRR=1.36, CI: 1.26–1.46) and scheduling appointments >31 days in advance (aRR=2.68, CI: 2.35–3.05) were also associated with an increased risk of a no-show outcome.

Implications:

The risk of a no-show outcome varies across patient subgroups and appointment characteristics, indicating that uniform reminder strategies are insufficient. Targeted, equity-focused interventions addressing structural and behavioral barriers may improve attendance, clinic efficiency, and continuity of care.