Automated Waitlists for Ambulatory Appointment Scheduling: Multisite, Mixed Methods Evaluation.

Background: Delays in access to ambulatory care are associated with adverse health outcomes, diminished patient experience, and increased system inefficiencies. US health systems have adopted automated waitlists, a technology-enabled tool that notifies patients of earlier appointment availability. Existing case reports suggest benefits. However, there is limited evidence on the efficacy of adopting, implementing, and sustaining an automated waitlist to improve access. Objective: The objective of this study was to evaluate automated waitlists to identify determinants that influence their adoption and ongoing use. Findings may inform health care organizations seeking to improve access to appointments in the ambulatory setting. Methods: A convergent, multisite, mixed methods study was conducted. Data were collected through a survey of 127 health systems, with 90 reporting data about automated waitlist usage, accompanied by a criterion-based purposive study of 10 participating health systems. Both qualitative and quantitative data were collected from the 10 participating systems. The Consolidated Framework for Implementation Research was used to report the determinants of the intervention's performance. Results: Automated waitlists provide benefits to US health systems. High-performing health systems reported that 38.8% (IQR 36.2%-45.7%) of appointments offered by the automated waitlist were filled. Participants reported a lower missed appointment rate (3.1%, IQR 2.5%-4.8%) for appointments scheduled via the automated waitlist, as compared to all appointments (6.6%, IQR 4.1%-9.9%). Flexible configuration serves as a key facilitator of adoption and maintenance. External pressures, including peer benchmarking and high patient demand, accelerated implementation. Insurance and records requirements, seasonality, care plan configuration, and digital inequities controlled which patients could benefit from the intervention. Additionally, specialty gatekeeping and clinician capacity constraints limited impact. Organizational context strongly shaped effectiveness, with cross-functional governance structures, leadership endorsement, and cultures of iteration enabling sustained use. Conclusions: Automated waitlists may offer a solution to health care organizations striving to positively impact access to care. The effectiveness of automated waitlists depends primarily on the implementation process and inner-setting organizational determinants. Rather than functioning as a stand-alone technical solution, automated waitlists are most impactful when integrated as a dynamic component of system-level scheduling infrastructure.