Determinants of Appointment Completion in Rehabilitative Care: The Role of Insurance, Program Structure, and Access...

To examine factors predicting health care appointment completion at Shepherd Center. Factors included sex, race, ethnicity, geographic location, level of rurality of residence, state of residence, appointment lead time, type of health care insurance, patient classification, COVID-19 era, and telehealth as predictors of appointment completion.

Bivariate analyses and binary logistic regressions were conducted on a dataset on patient visits. Data were retrieved from Shepherd Center's patient portals.

Patients with ≥1 health care appointment at Shepherd Center between March 19, 2020, and February 28, 2025 (N=19,453). The main unit of analysis was health care appointments (N=1,105,752).

Health care appointment completion.

Insurance type and visit department significantly predicted appointment completion. Compared with private, public (B=-0.352), self-pay (B=-0.174), and other insurance types (B=-3.711) were associated with lower odds of completion (P<.001). Medical visits had increased odds of appointment completion (B=1.301), whereas occupational therapy (B=-0.953), physical therapy (B=-0.703), speech-language pathology (B=-0.943), and psychology departments (B=-1.025) reduced odds for appointment completion (P<.001). Telehealth occurred as a positive predictor of appointment completion in early models (B=0.345-0.426, P<.001). However, when accounting for insurance and departments, it lowered completion odds. Sociodemographic variables did not strongly predict appointment completion (all P<.001).

Although sociodemographic factors were significant predictors of appointment completion, health care insurance type and appointment department emerged as the strongest predictors. Financial security and access to health care are foundational to patient engagement in rehabilitation settings. To improve appointment completion and promote equitable access to rehabilitation services, health care systems must adopt multifaceted strategies that address underlying financial, administrative, and accessibility challenges.