51 Vol. 41, No. 1 Practice Management Delays are common for patients seeking primary care services, with wait times for appointments as high as 60 days. 1,2 For academic practices, this delayed ac- cess is exacerbated by interrupted continuity clinic schedules, day-to-day variation in provider availability, and communication dificulties when residents are on hospital-based rotations that limit their ambulatory clinical time. 3 Advanced access scheduling is recommended as a way for ambulatory practices to improve both access and continuity at the same time. Advanced access gives patients the ability to schedule an appointment with the provider of their choice, for virtually any service, within a day or two. 4 Many non-academic practices have experienced success with this scheduling model by demonstrating increased appointment availability, reduced no-show rates, increased patient satisfaction, and increased revenues. 2,5-9 Additionally, the Institute for Healthcare Improvement (IHI) has shown that advanced access scheduling increases the proportion of visits that are with a patient’s primary provider, which increases the likelihood of a patient arriving for a visit. 11 Some academic practices have seen a decrease in no-show appointment rates with the introduction of advanced access and attributed subsequent increases in visit volumes to this reduction. 10 Others, however, did not see an improvement in no-show rates. 12 This discrepancy may be due to a myriad of factors that have been shown to inluence no-show rates, such as insur- ance status, clinical characteristics of the patient, type of provider to be seen, and system characteristics. 13-15 Since the relationship between advanced access scheduling and no-show rates in academic settings is unclear, further study is warranted. The purpose of this analysis is to assess the effect of moving to a form of advanced access scheduling system on no-show appointment frequency within an academic practice. Our no-show rate in the year before we implemented advanced access varied each month between 20%–25%. Unlike previous studies that only examined no-show rate as one of many outcomes of advanced access imple- mentation, we will examine the factors associated with no-shows within this environment in more detail. The Effect of a Carve-out Advanced Access Scheduling System on No-show Rates Kevin J. Bennett, PhD; Elizabeth G. Baxley, MD From the Department of Family and Preventive Medicine, University of South Carolina. Background and Objectives: The relationship between advanced access scheduling and no-show rates in academic settings is unclear. The purpose of this analysis is to assess the effect of moving to a carve-out model of an advanced access scheduling system on no-show rates in an academic practice. Methods: A multivariable logistic regression with repeated measures analysis of patient visits was used to assess the relationship between the time to third-next available appointment and no-show rates. Results: The time to third-next available appointment was not a signiicant factor in appointment- keeping behavior. Rather, provider-patient continuity, wait time for an appointment, the number of previous appointments, and type of provider were strong predictors of a patient no-show. Conclusions: Implementation of the concepts of advanced access scheduling does not directly result in a reduction in no-show rates; rather, provider-patient continuity, wait time to an appointment, and other factors may be a more important measure. (Fam Med 2009;41(1):51-6.)