Predictors of Patient-Related Cancellations and No-Shows for Pediatric Orthopaedics and Sports Medicine Appointments Are Condition Specific Original Research
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Background: Visit cancellations have detrimental effects on patient health and reduce clinic productivity. We sought to understand the factors that influence cancellation rates across the major subspecialties in pediatric orthopedics and sports medicine (OSM).
Methods: In-person OSM visits from a high-volume multi-site academic pediatric hospital (01/01/2019-02/28/2020) were used to study the effect of patient demographics, distance to clinic, insurance type, visit type (new vs follow-up) on visit cancellation (cancelled by patient and no-shows). When available, chief complaint was used to categorize visits into major subspecialties: cerebral palsy, foot and ankle, hip, knee, other lower extremity, spine, and upper extremity. Logistic regression was used to identify contributors to the visit cancellations in both univariate (unadjusted) and multivariate (adjusted) settings.
Results: 424,397 visits (15.9% canceled) were included in the analysis. In the unadjusted analysis, new visit (OR=1.479), public insurance (OR=1.263), higher median household income (OR=1.004 per $10,000), female sex (OR=1.116), and older age (OR=1.006) were independently associated with higher cancelations, whereas being non-English speaking was associated with lower cancellations (OR=0.796, P<.001). In the adjusted analysis, being non-white (OR=1.139), Hispanic (OR=1.133), older age (OR=1.007), female (OR=1.046), living farther from clinic (OR=1.002), and having public insurance (OR=1.163) were associated with higher cancelations, whereas median household income (OR=0.994, per $10,000) and new visit (OR=0.969) were associated with lower cancellations (P<.04). 241,305 visits categorized into subspecialties. The effects of studied patient-related factors and visit types on cancellations were highly variable across subspecialties. Having public insurance (hip, lower extremity, upper extremity), living farther from the clinic and being an English speaker (all subspecialties) were the only factors with consistent effect (increased odds) on cancellations. The remaining factors showed variable effects.
Conclusion: Disparities exist in patient-related visit cancellations in pediatric and young-adult OSM with different patterns across major OSM subspecialties. These findings highlight the importance of looking at these specific orthopedic conditions separately to develop more effective strategies to improve patient compliance and efficiently utilize healthcare resources.