721 - Telemedicine and Missed Appointments among Pediatric Patients of an Academic Safety-Net System

Publication Number: 721.6550

Chinedum Ojinnaka, Indiana University School of Public Health, Indianapolis, IN, United States; Lara L. Johnstun, Valleywise Health, Chandler, AZ, United States; Lora Nordstrom, Valleywise Health, Phoenix, AZ, United States; Jodi P.. Carter, District Medical Group/Valleywise Health, Phoenix, AZ, United States; Sandra Yuh, Creighton University School of Medicine, Phoenix, AZ, United States

Background: Missed appointments negatively impact clinical outcomes, quality of care, and clinic efficiency, exacerbating the effects of pediatric workforce shortages on healthcare access. Telemedicine could help decrease missed appointments, but a limited understanding of the role of neighborhood factors can widen disparities

Objective: We examined the association between missed appointments and the type of pediatric appointment, the influence of telemedicine, and neighborhood characteristics.

Design/Methods: Electronic health records of a safety-net academic healthcare system were merged with the American Community Survey and the Housing and Urban Development crosswalk data. The analyses were restricted to pediatric patients ( < 18 years) with completed or missed outpatient appointments (03/2020-12/2022). The outcome was missed appointments. The primary predictors were pediatric visit type (general versus specialty), appointment modality (in-person versus telemedicine), census tract (CT) residential segregation, and CT poverty level. Generalized estimating equation regression models were used to analyze the relationship between the outcome and predictor variables.

Results: The final sample size was 90,712 appointments for 32,305 unique patients. The overall no-show rate was 20.75%. There was a higher rate of missed appointments for specialty appointments (27.82%) compared to general appointments (20.36%). On multivariable analyses, there was an increased likelihood of missed appointments for pediatric subspecialty appointments compared to general pediatrics (OR:1.62; 95% CI: 1.51, 1.74). Telemedicine appointments were associated with a decreased likelihood of missed appointments compared to in-person appointments (OR:0.41; 95% CI:0.39, 0.44). There was a positive interaction between appointment type and pediatrics visit type with a larger effect for specialty visits.

Conclusion(s): Interventions to increase telemedicine use in pediatric clinics have the potential to reduce missed appointment rates, especially in pediatric specialty clinics.