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Understanding Non-Attendance in Pediatric Otolaryngology: A Retrospective Study of Demographics, Socioeconomics, and
Elizabeth M Puyo1, Henry Bayly2, Neha Garg1
1Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
Insights
Pediatric otolaryngology no-shows are linked to older age and race, with COVID-19 impacting attendance. Telemedicine visits significantly reduce missed appointments compared to in-person visits.
Area of Science:
- Pediatric Otolaryngology
- Health Services Research
- Health Equity
Background:
- Missed appointments in pediatric otolaryngology are a significant issue at safety net hospitals.
- Understanding factors contributing to no-shows is crucial for improving patient access and care continuity.
Purpose of the Study:
- To identify demographic, socioeconomic, COVID-related, and appointment-specific factors associated with missed pediatric otolaryngology appointments.
- To analyze changes in appointment attendance patterns before, during, and after the COVID-19 pandemic.
Main Methods:
- Retrospective chart review of 13,868 pediatric otolaryngology outpatient appointments from May 2015 to May 2022.
- Analysis of electronic medical record data including patient demographics, appointment status, and visit type.
- Binary mixed-effects modeling to determine predictors of no-show appointments across different time periods.
Main Results:
- Overall no-show rate was 19.2% (3,287 patients).
- Older age and Black/African American race were associated with increased likelihood of no-shows.
- Telemedicine visits had significantly lower no-show rates compared to in-person visits; post-COVID appointments showed higher no-show rates than pre-COVID.
Conclusions:
- Appointment non-attendance is influenced by patient demographics, socioeconomic status, and the shift towards telemedicine.
- Significant racial disparities exist in appointment adherence.
- The COVID-19 pandemic has reshaped healthcare dynamics, highlighting telemedicine's role in improving access and adherence for pediatric otolaryngology services.
Objective:
The objective of this study is to identify factors associated with missed pediatric otolaryngology appointments at a large safety net hospital, focusing on demographic, socioeconomic, COVID-related, and appointment-related factors.
Methods:
A retrospective chart review was conducted on children (<18 years old) with scheduled outpatient appointments in the otolaryngology department from May 1, 2015, to May 1, 2022. Data were extracted from the EMR, encompassing appointment-related factors (eg, status and type) and patient demographics (age, sex, race, ethnicity, and zip code). Statistical analyses utilized a binary mixed-effects model to identify predictors of appointment non-attendance across pre-COVID, during COVID, and post-COVID periods.
Results:
Out of 13 868 patients, 3287 (19.2%) were classified as no-show. Older age increased the likelihood of missing appointments (OR = 1.015, 95% CI [1.003, 1.027]). Black/African American patients were more likely to not show up (OR = 1.676, 95% CI [1.376, 2.04]), and there was no significant difference in attendance by sex or ethnicity. Participants residing in regions outside of Boston and those with private insurance (OR = 0.549, 95% CI [0.460, 0.654]) were less likely to miss appointments. Patients with appointments after the COVID-19 pandemic were more likely to no-show compared to pre-pandemic (OR = 1.187, 95% CI [1.068, 1.319]). In-person appointments had a significantly higher no-show rate compared to telemedicine visits (OR = 63.953, 95% CI [26.696, 137.729]).
Conclusions:
Non-attendance in pediatric otolaryngology clinics is affected by various demographic and socioeconomic factors, revealing significant disparities among racial groups and age categories. The COVID-19 pandemic altered attendance patterns, indicating changes in healthcare dynamics and patient behavior and reinforcing the benefits of telemedicine. These findings underscore the need for future research to incorporate parental perspectives to understand barriers that caregivers face when bringing their children to clinic visits. Engaging families and exploring their specific challenges can inform targeted interventions aimed at improving appointment adherence in pediatric otolaryngology.
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