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Factors Associated With Pretreatment Patient Attrition in an Advanced Orthodontic Education Clinic: A Cross-Sectional
Jeff Hage1, Henry W Fields1, William M Johnston2
1Division of Orthodontics, College of Dentistry, Ohio State University, Columbus, Ohio, USA.
Objectives:
This cross-sectional study investigated factors associated with pretreatment patient attrition in an advanced education orthodontic clinic.
Materials And Methods:
Clinical records of 1567 patients attending screening and 829 patients attending records appointments in 2022-2024 were accessed. Attrition, the dependent variable, was defined as discontinuation of care despite a recommendation to proceed. Independent variables included patient's age, gender, home-to-clinic distance, case category, insurance type, prospect of Medicaid coverage, case complexity, recommended treatment plan and appliance, and time between screening and records appointments. Medicaid patients were first analyzed for attrition rate variation with clinically estimated prospect of obtaining Medicaid coverage by Chi-squared tests. Then, with both Medicaid and private-pay patients included, binary logistic regression tests were conducted to assess factors related to attrition followed by sensitivity analysis for missing values.
Results:
Attrition rate reduced from 51.2% after screening to 24.1% after the records appointment. Among Medicaid patients, attrition rate after the screening appointment rose significantly with declining clinically-estimated prospect of obtaining Medicaid coverage (p < 0.0001). Among all other independent factors investigated, attrition after the screening appointment increased significantly with patient's age (p < 0.001), whereas attrition after the records appointment increased significantly with orthognathic surgery treatment plans (p < 0.01) and tended to have higher odds of attrition among Medicaid patients than private-pay patients (p = 0.001).
Conclusions:
Pretreatment patient attrition in an advanced education orthodontic setting may improve from the screening to the records appointment; age increase, treatment plans that involve orthognathic surgery and unapproved insurance coverage for Medicaid patients are likely the main contributors to attrition.
