Factors Affecting Medical Appointment Adherence among Adolescents and Young Adults with Kidney Disease: A...

To identify patient-, health-, and visit-level factors associated with medical appointment adherence among adolescents and young adults (AYA) with pediatric-onset chronic kidney conditions and to assess whether multiple prescheduled appointments on the same day ("bundling") and preceding disease severity influence attendance and disparities.

This retrospective longitudinal cohort study used electronic medical record data from a single academic children's hospital (2005-2015). AYA (n = 353) with chronic kidney disease or systemic illnesses affecting the kidney had 37 371 scheduled outpatient appointments. The outcome was medical appointment adherence (completed, cancelled, or no-show). Covariates included demographics (eg, age, sex, race/ethnicity, insurance), disease characteristics (eg, recent estimated glomerular filtration rate, transplant status), and appointment features (eg, time since last visit, clinic type, weather). Multinomial logit models with patient-level clustering were estimated, stratified by disease severity and by single vs multiple appointments per day.

No-show rates were greater among African American patients and those with Medicaid or self-pay insurance. Older age was also associated with lower adherence. On days with multiple scheduled appointments, overall attendance improved and insurance-related disparities were attenuated; among patients receiving Medicaid, no-show differences observed on single-appointment days were reduced on bundled days. Findings were directionally consistent across disease-severity strata.

Having ≥2 scheduled appointments on the same day is associated with improved attendance and reduced disparities in AYA with chronic kidney conditions. Health-system strategies that facilitate appointment bundling (eg, co-locating services and coordinated scheduling) could be a pragmatic quality-improvement target to improve equity and continuity of care.