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Patient Factors Associated with Missed Otolaryngology Appointments at an Urban Safety-Net Hospital
Carolyn A Wilson1, Taylor L Jamil1,2,3, Preetha S Velu1
1Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, U.S.A.
Insights
Patients with lower socioeconomic status (SES) and certain demographic factors were more likely to miss otolaryngology appointments. However, after controlling for social determinants of health, these factors were no longer significant predictors of missed appointments.
Area of Science:
- Otolaryngology
- Health Services Research
- Health Equity
Background:
- Missed appointments in otolaryngology clinics pose significant challenges to patient care and healthcare system efficiency.
- Understanding patient and appointment-related factors influencing missed appointments is crucial for developing targeted interventions.
Purpose of the Study:
- To identify patient demographic, socioeconomic, comorbidity, and appointment characteristics associated with missed initial adult otolaryngology appointments.
- To assess the impact of social determinants of health on appointment attendance.
Main Methods:
- Retrospective case-control study at Boston Medical Center in 2019.
- Comparison of demographic, comorbidity, and appointment data between patients who attended and those who missed their initial otolaryngology appointment.
- Multivariate regression analysis to control for social determinants of health.
Main Results:
- Initially, female sex, lower education, disability, unemployment, Black/Hispanic ethnicity, and Spanish language were associated with higher missed appointment rates.
- Spring and Fall appointments were more frequently missed.
- After controlling for social determinants of health (race, insurance, employment, education), the increased odds of missing appointments for females, Spanish-speakers, students, and disabled patients were no longer statistically significant.
Conclusions:
- While initial analysis identified demographic and socioeconomic factors linked to missed otolaryngology appointments, multivariate analysis controlling for social determinants of health revealed these associations were not independent.
- Patients residing closer to the medical center, often in lower-income areas, had higher missed appointment rates.
- Interventions including reduced wait times, accessible transportation, and enhanced telemedicine could improve appointment attendance.
Objective:
To determine if patient factors related to ethnicity, socioeconomic status (SES), medical comorbidities, or appointment characteristics increase the risk of missing an initial adult otolaryngology appointment.
Methods:
This study is a retrospective case control study at Boston Medical Center (BMC) in Boston, Massachusetts, that took place in 2019. Patient demographic and medical comorbidity data as well as appointment characteristic data were collected and compared between those that attended their initial otolaryngology appointment versus those who missed their initial appointment. Chi-square and ANOVA tests were used to calculate differences between attendance outcomes. Multivariate analysis was used to compare the odds of missing an appointment based on various patient- and appointment-related factors.
Results:
Patients who were more likely to miss their appointments were more often female, of lower education, disabled, not employed, Black or Hispanic, and Spanish-speaking. Spring and Fall appointments were more likely to be missed. When a multivariate regression was conducted to control for social determinants of health (SDOH) such as race, insurance status, employment, and education status, the odds of females, Spanish-speaking, students, and disabled patients missing their appointment were no longer statistically significant.
Conclusion:
A majority of patients at BMC come from lower SES backgrounds and have multiple medical comorbidities. Those who reside closer to BMC, often areas of lower average income, had higher rates of missed appointments. Interventions such as decreasing lag time, providing handicap-accessible free transportation, and increasing accessibility of telemedicine for patients could help improve attendance rates at BMC.
Level Of Evidence:
IV Laryngoscope, 134:4003-4010, 2024.
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