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Wang H, Yao B, Tang T, Gong M, Ma Y, Wu X, Zhu B. Racial/ethnic disparities in all-cause and cause-specific death among children with malignant central nervous system tumours: a registry-based cohort retrospective analysis. EClinicalMedicine 2024; 76:102816. [PMID: 39290638 PMCID: PMC11405826 DOI: 10.1016/j.eclinm.2024.102816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 08/16/2024] [Accepted: 08/21/2024] [Indexed: 09/19/2024] Open
Abstract
Background It is generally recognized that there is unequal mortality in childhood central nervous system (CNS) malignancy in the United States (US), but little is known about the trends and contributors of racial/ethnic disparities in death. We assessed the trends of racial/ethnic disparities in all-cause and cause-specific death, and the contributions of tumour, treatment and socioeconomic factors to this disparity. Methods This registry-based cohort study included children (aged ≤19 years) diagnosed with malignant CNS tumours, using data from the US population-based cancer registry in the Surveillance, Epidemiology, and End Results (SEER) Program. The clinical outcomes were all-cause and cause-specific death for each racial/ethnic group (White, Black, Hispanic, non-Hispanic Asian/Pacific Islander [API], and non-Hispanic American Indian/Alaska Native [AI/AN] children). We quantified absolute disparities using absolute rate difference in 5-year cumulative incidence of death. Cox proportion risk models were used to estimate the relative racial/ethnic disparities, and the contribution of factors to disparities in death. Findings In this study, data from 14,510 children with malignant CNS tumours (mean [SD] age, 8.5 [5.7]; 7988 [55.1%] male) were analysed. Overall, the cumulative incidence of death from CNS tumours across four racial/ethnic groups decreased from 2001 to 2020. Black patients had the highest risk of death from all causes and CNS tumours between 2001 and 2020, with adjusted hazard ratios (HR) of 1.52 (1.38-1.68) and 1.47 (1.31-1.64), respectively. The absolute disparity in all-cause death between Hispanic and White patients increased slightly (from 8.2 percentage points [ppt] to 9.4 ppt), and the relative disparity in death from CNS tumours increased from 1.33 (1.15-1.55) in 2001-2005 to 1.78 (1.44-2.20) in 2016-2020. The absolute disparities in death from CNS tumours between Black and White patients (from 11.8 ppt to 4.3 ppt) and between API and White patients (from 10.1 ppt to 5.1 ppt) decreased from 2001-2005 to 2011-2015. Interpretation Race/ethnicity disparities in death from CNS tumours among childhood malignant CNS tumours had reduced from 2001 to 2020, and quantifying the contribution of factors to this disparity in death could provide a basis for decreasing mortality among racial/ethnic minority patients. Funding Shenyang Young and Middle-aged Science and Technology Innovation Talent Support Program.
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Affiliation(s)
- Hongying Wang
- Department of Cancer Prevention and Treatment, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, Liaoning Province, China
| | - Bing Yao
- Department of Neurosurgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, Liaoning Province, China
| | - Tao Tang
- Department of Neurosurgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, Liaoning Province, China
| | - Meixi Gong
- Department of Cancer Prevention and Treatment, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, Liaoning Province, China
| | - Yuansen Ma
- Department of Cancer Prevention and Treatment, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, Liaoning Province, China
| | - Xiaomei Wu
- Department of Clinical Epidemiology and Centre of Evidence Based Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Bo Zhu
- Department of Cancer Prevention and Treatment, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, Liaoning Province, China
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Gallo-Bernal S, Peña-Trujillo V, Briggs D, Machado-Rivas F, Pianykh OS, Flores EJ, Gee MS. A data science-based analysis of socioeconomic determinants impacting pediatric diagnostic radiology utilization during the COVID-19 pandemic. Pediatr Radiol 2024:10.1007/s00247-024-06039-8. [PMID: 39289213 DOI: 10.1007/s00247-024-06039-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/20/2024] [Accepted: 08/21/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND Research on healthcare disparities in pediatric radiology is limited, leading to the persistence of missed care opportunities (MCO). We hypothesize that the COVID-19 pandemic exacerbated existing health disparities in access to pediatric radiology services. OBJECTIVE Evaluate the social determinants of health and sociodemographic factors related to pediatric radiology MCO before, during, and after the COVID-19 pandemic. MATERIALS AND METHODS The study examined all outpatient pediatric radiology exams at a pediatric medical center and its affiliate centers from 03/08/19 to 06/07/21 to identify missed care opportunities. Logistic regression with the least absolute shrinkage and selection operator (LASSO) method and classification and regression tree (CART) analysis were used to explore factors and visualize relationships between social determinants and missed care opportunities. RESULTS A total of 62,009 orders were analyzed: 30,567 pre-pandemic, 3,205 pandemic, and 28,237 initial recovery phase. Median age was 11.34 years (IQR 5.24-15.02), with 50.8% females (31,513/62,009). MCO increased during the pandemic (1,075/3,205; 33.5%) compared to pre-pandemic (5,235/30,567; 17.1%) and initial recovery phase (4,664/28,237; 16.5%). The CART analysis identified changing predictors of missed care opportunities across different periods. Pre-pandemic, these were driven by exam-specific factors and patient age. During the pandemic, social determinants like income, distance, and ethnicity became key. In the initial recovery phase, the focus returned to exam-specific factors and age, but ethnicity continued to influence missed care, particularly in neurological exams for Hispanic patients. Logistic regression revealed similar results: during the pandemic, increased distance from the examination site (OR 1.1), residing outside the state (OR 1.57), Hispanic (OR 1.45), lower household income ($25,000-50,000 (OR 3.660) and $50,000-75,000 (OR 1.866)), orders for infants (OR 1.43), and fluoroscopy (OR 2.3) had higher odds. In the initial recovery phase, factors such as living outside the state (OR 1.19), orders for children (OR 0.79), and being Hispanic (OR 1.15) correlate with higher odds of MCO. CONCLUSION The application of basic data science techniques is a valuable tool in uncovering complex relationships between sociodemographic factors and disparities in pediatric radiology, offering crucial insights into addressing inequalities in care.
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Affiliation(s)
- Sebastian Gallo-Bernal
- Massachusetts General Hospital, 55 Fruit St, Austen 250, Boston, MA, 02114, USA
- Harvard University, Cambridge, MA, USA
| | - Valeria Peña-Trujillo
- Massachusetts General Hospital, 55 Fruit St, Austen 250, Boston, MA, 02114, USA
- Harvard University, Cambridge, MA, USA
| | - Daniel Briggs
- Massachusetts General Hospital, 55 Fruit St, Austen 250, Boston, MA, 02114, USA
- Harvard University, Cambridge, MA, USA
| | - Fedel Machado-Rivas
- Massachusetts General Hospital, 55 Fruit St, Austen 250, Boston, MA, 02114, USA
- Harvard University, Cambridge, MA, USA
| | - Oleg S Pianykh
- Massachusetts General Hospital, 55 Fruit St, Austen 250, Boston, MA, 02114, USA
- Harvard University, Cambridge, MA, USA
| | - Efren J Flores
- Massachusetts General Hospital, 55 Fruit St, Austen 250, Boston, MA, 02114, USA
- Harvard University, Cambridge, MA, USA
| | - Michael S Gee
- Massachusetts General Hospital, 55 Fruit St, Austen 250, Boston, MA, 02114, USA.
- Harvard University, Cambridge, MA, USA.
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Cuyegkeng A, Hao Z, Rashidi A, Bansal R, Dhillon J, Sadigh G. Prevalence of financial hardship and health-related social needs among patients with missed radiology appointments. Clin Imaging 2024; 113:110232. [PMID: 39096889 DOI: 10.1016/j.clinimag.2024.110232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/23/2024] [Accepted: 07/08/2024] [Indexed: 08/05/2024]
Abstract
PURPOSE We aimed to evaluate the prevalence of financial hardship and Health-Related Social Needs (HRSN) among patients who missed their radiology appointment. METHODS English-speaking adult patients, with a missed outpatient imaging appointment at any of a tertiary care imaging centers between 11/2022 and 05/2023 were eligible. We measured self-reported general financial worry using Comprehensive Score for Financial Toxicity (COST), imaging hardship (worry that the current imaging is a financial hardship to patient and their family), material hardship (e.g., medical debt), cost-related care nonadherence, and HRSNs including housing instability, food insecurity, transportation problems, and utility help needs. RESULTS 282 patients were included (mean age 54.7 ± 15.0 years; 70.7 % female). Majority were non-Hispanic White (52.4 %), followed by Asian (23.0 %) and Hispanic (16.0 %) racial/ethnic background. Most missed appointments were patient-initiated (74.8 %); 13.5 % due to cost or insurance coverage and 6.4 % due to transportation and parking. Mean COST score was 26.8 with 44.4 % and 28.8 % reporting their illness and imaging as a source of financial hardship. 18.3 % and 35.2 % endorsed cost-related care nonadherence and material hardship. 32.7 % had at least one HRSNs with food insecurity the most common (25.4 %). Only 12.5 % were previously screened for financial hardship or HRSNs. Having comorbidity and living in more disadvantaged neighborhoods was associated with higher report of financial hardship and HRSNs. CONCLUSION Financial hardship and HRSNs are common among those who miss radiology appointments. There needs to be more rigorous screening for financial hardship and HRSNs at every health encounter and interventions should be implemented to address these.
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Affiliation(s)
- Andrew Cuyegkeng
- Department of Radiological Sciences, University of California, Irvine, CA 92677, United States of America
| | - Zuxian Hao
- Department of Radiological Sciences, University of California, Irvine, CA 92677, United States of America
| | - Ali Rashidi
- Department of Radiological Sciences, University of California, Irvine, CA 92677, United States of America
| | - Riya Bansal
- Department of Radiological Sciences, University of California, Irvine, CA 92677, United States of America
| | - Jasmine Dhillon
- Department of Radiological Sciences, University of California, Irvine, CA 92677, United States of America
| | - Gelareh Sadigh
- Department of Radiological Sciences, University of California, Irvine, CA 92677, United States of America.
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Borkhetaria RK, Hussain ZS, Giang V, Ely AL. Predictors of No-Show Status: An Analysis of Pediatric Ophthalmology Patients at an Academic Ophthalmology Department in the United States. J Pediatr Ophthalmol Strabismus 2024:1-10. [PMID: 39141769 DOI: 10.3928/01913913-20240718-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
PURPOSE To identify pediatric patient and appointment characteristics associated with no-show status at a tertiary care pediatric ophthalmology clinic within a U.S. academic ophthalmology department. METHODS A cross-sectional retrospective chart review was performed for all pediatric patients with a scheduled ophthalmology appointment at the Penn State Eye Center between April 1, 2022 and March 31, 2023. A multivariate logistic regression analysis assessed associations between appointment nonattendance and patient characteristics. RESULTS Of 8,083 scheduled visits, 1,445 (17.9%) were no-shows. Factors associated with no-show status included appointment type (new vs return odds ratio [OR]: 1.43, 95% CI: 1.26 to 1.63, P < .001); lower median household income (< $41,374 vs > $68,957 OR: 1.89, 95% CI: 1.40 to 2.55, P < .001; $41,374 to $68,957 vs > $68,957 OR: 1.27, 95% CI: 1.12 to 1.44, P < .001); non-private insurance (self-pay vs private: OR: 5.65, 95% CI: 3.87 to 8.24, P < .001, Medicaid vs private: OR: 2.17, 95% CI: 2.32 to 3.16, P < .001); commute distance 10 to 30 miles vs < 5 miles (OR: 1.49, 95% CI: 1.11 to 1.99, P = .008); race: unavailable vs White (OR: 2.18, 95% CI: 1.66 to 2.85, P < .001), Black vs White (OR: 1.86, 95% CI:1.53 to 2.27, P < .001), Other vs White (OR: 1.47, 95% CI: 1.27 to 1.70, P < .001); ethnicity: Hispanic vs non-Hispanic (OR: 1.92, 95% CI: 1.62 to 2.27, P < .001); and language preference: Spanish vs English (OR: 1.86, 95% CI: 1.49 to 2.32, P < .001), Nepali vs English (OR: 1.60, 95% CI: 1.06 to 2.43, P = .027), other vs English (OR: 1.83, 95% CI: 1.35 to 2.49, P < .001). Appointment reminders (phone call, P = .013); text message, P < .001; other, P = .013) all resulted in a greater propensity to show, but email communication alone did not (P = .674). CONCLUSIONS Certain patient and appointment characteristics that are linked to a higher rate of no-show status can inform targeted initiatives to improve health care outcomes, resource utilization, and clinical efficiency in the pediatric ophthalmology community. [J Pediatr Ophthalmol Strabismus. 20XX;X(XX):XXX-XXX.].
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Lacson R, Pianykh O, Hartmann S, Johnston H, Daye D, Flores E, Kapoor N, Khorasani R. Factors Associated With Timeliness and Equity of Access to Outpatient MRI Examinations. J Am Coll Radiol 2024; 21:1049-1057. [PMID: 38215805 DOI: 10.1016/j.jacr.2023.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVE The role of MRI in guiding patients' diagnosis and treatment is increasing. Therefore, timely MRI performance prevents delays that can impact patient care. We assessed the timeliness of performing outpatient MRIs using the socio-ecological model approach and evaluated multilevel factors associated with delays. METHODS This institutional review board-approved study included outpatient MRI examinations ordered between October 1, 2021, and December 31, 2022, for performance at a large quaternary care health system. Mean order-to-performed (OtoP) interval (in days) and prolonged OtoP interval (defined as >10 days) for MRI orders with an expected date of 1 day to examination performance were measured. Logistic regression was used to assess patient-level (demographic and social determinants of health), radiology practice-level, and community-level factors associated with prolonged OtoP interval. RESULTS There were 126,079 MRI examination orders with expected performance within 1 day placed during the study period (56% of all MRI orders placed). After excluding duplicates, there were 97,160 orders for unique patients. Of the MRI orders, 48% had a prolonged OtoP interval, and mean OtoP interval was 18.5 days. Factors significantly associated with delay in MRI performance included public insurance (odds ratio [OR] = 1.11, P < .001), female gender (OR = 1.11, P < .001), radiology subspecialty (ie, cardiac, OR = 1.71, P < .001), and patients from areas that are most deprived (ie, highest Area Deprivation Index quintile, OR = 1.70, P < .001). DISCUSSION Nearly half of outpatient MRI orders were delayed, performed >10 days from the expected date selected by the ordering provider. Addressing multilevel factors associated with such delays may help enhance timeliness and equity of access to MRI examinations, potentially reducing diagnostic errors and treatment delays.
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Affiliation(s)
- Ronilda Lacson
- Associate Director, Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, and Associate Professor of Radiology, Harvard Medical School, Boston, Massachusetts.
| | - Oleg Pianykh
- Assistant Professor of Radiology, Harvard Medical School, Boston, Massachusetts; and Director of Medical Analytics, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sean Hartmann
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Heather Johnston
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Dania Daye
- Assistant Professor of Radiology, Harvard Medical School, Boston, Massachusetts; and Quality Director, Interventional Radiology Division, and Co-Director of IR Research, Division of Vascular and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Efren Flores
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Associate Professor of Radiology, Harvard Medical School, Boston, Massachusetts; and Vice Chair, Diversity, Equity & Inclusion, Mass General Brigham, Boston, Massachusetts; Vice Chair of Radiology, Distinguished Chair, Medical Informatics, and Director of Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Professor of Radiology, Harvard Medical School, Boston, Massachusetts; and Vice Chair, Radiology Quality and Safety, Mass General Brigham, Boston, Massachusetts
| | - Neena Kapoor
- Director of Diversity, Inclusion, and Equity and Quality and Safety Officer, Department of Radiology, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; and Assistant Professor of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Ramin Khorasani
- Vice Chair of Radiology, Distinguished Chair, Medical Informatics, and Director of Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Professor of Radiology, Harvard Medical School, Boston, Massachusetts; and Vice Chair, Radiology Quality and Safety, Mass General Brigham, Boston, Massachusetts
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Harrington S, Kwatra N, Melvin P, Tartarilla AB, Whitley MY, Valencia VF, Ward VL. Sociodemographic factors and Child Opportunity Index disparities associated with missed care opportunities in pediatric patients with lymphoma and leukemia referred for FDG-PET/CT. Pediatr Radiol 2024; 54:1022-1032. [PMID: 38632134 DOI: 10.1007/s00247-024-05924-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 04/04/2024] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Little data exists on the association of missed care opportunities (MCOs) in children referred for nuclear medicine/nuclear oncology imaging examinations and socioeconomic disparities. OBJECTIVE To determine the prevalence of MCOs in children with lymphoma/leukemia scheduled for fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) and the impact of sociodemographic factors and Child Opportunity Index (COI). MATERIALS AND METHODS Retrospective analysis of MCOs in children with lymphoma/leukemia scheduled for FDG-PET/CT (2012 to 2022) was performed. In univariate analysis, patient, neighborhood, and appointment data were assessed across MCOs and completed appointments. Logistic regression evaluated independent effects of patient-, neighborhood-, and appointment-level factors with MCOs. Two-sided P-value < .05 was considered statistically significant. RESULTS In 643 FDG-PET/CT appointments (n = 293 patients; median age 15 years (IQR 11.0-17.0 years); 37.9% female), there were 20 MCOs (3.1%) involving 16 patients. Only 8.2% appointments involved Black/African American non-Hispanic/Latino patients, yet they made up a quarter of total MCOs. Patients living in neighborhoods with very low or low COI experienced significantly higher MCOs versus zip codes with very high COI (6.9% vs. 0.8%; P = 0.02). Logistic regression revealed significantly increased likelihood of MCOs for patients aged 18 to 21 [odds ratio (OR) 4.50; 95% CI 1.53-13.27; P = 0.007], Black/African American non-Hispanic/Latino (OR 3.20; 95% CI 1.08-9.49; P = 0.04), zip codes with very low or low COI (OR 9.60; 95% CI 1.24-74.30; P = 0.03), and unknown insurance status. CONCLUSION Children with lymphoma/leukemia, living in zip codes with very low or low COI, and who identified as Black/African American non-Hispanic/Latino experienced more MCOs. Our study supports the need to address intersecting sociodemographic, neighborhood, and health system factors that will improve equitable access to necessary healthcare imaging for children.
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Affiliation(s)
| | - Neha Kwatra
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Patrice Melvin
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
| | - Ashley B Tartarilla
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
| | - Melicia Y Whitley
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
| | | | - Valerie L Ward
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
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Cleary M, Edwards C, Mitchell-Watson J, Yang J, Reddan T. Benchmarking non-attendance patterns in paediatric medical imaging: A retrospective cohort study spotlighting First Nations children. Radiography (Lond) 2024; 30:492-499. [PMID: 38232461 DOI: 10.1016/j.radi.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024]
Abstract
INTRODUCTION Non-attendance at Medical Imaging (MI) appointments can result in inefficiencies in healthcare resource allocation, increased financial burdens, and lead to potential barriers to effective healthcare delivery. We evaluated factors associated with non-attendance of MI appointments for children including variables: gender; age groups; residential postcodes; Indigenous status; appointment dates; appointment reminders and socio-economic status. METHOD Retrospective cohort study of children with scheduled MI appointments at a Tertiary paediatric hospital in Australia, between January and December 2022. Data were extracted from the Radiology Information System and integrated with socio-economic census data through linking with postcode. Chi-squared, and logistic regression analysis were performed to identify significant predictors of non-attendance. RESULTS Out of 17,962 scheduled outpatient appointments, 6.2 % did not attend. Males were less likely to attend than females (7.3 % vs. 5.8 %; p < 0.001). Older children had the highest frequency of non-attendance (p < 0.001). First Nations identified children had a higher likelihood of non-attendance at 14.5 % compared to non-First Nations at 5.8 %, and the odds ratio (OR) of First Nation children not attending was 2.54 (CI 2.13-3.03; p < 0.001) higher than non-First Nations children. Children from areas of disadvantage were less likely to attend (p < 0.001). Bone mineral densitometry had the highest odds of non-attendance (19.4 % of bookings) compared to other imaging modalities (p < 0.001). CONCLUSION The following characteristics were associated with non-attendance: older male gender, residing in areas of socio-economic disadvantage, or identifying as First Nations Australians. By reviewing these findings with the cultural and professional experience of our Indigenous co-author, we have identified some strategies for improving attendance amongst First Nations children. IMPLICATIONS FOR PRACTICE Factors associated with non-attendance, or "missed opportunities for care", provide opportunities for intervention to improve attendance for vulnerable groups of children who require medical imaging.
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Affiliation(s)
- M Cleary
- School of Pharmacy, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
| | - C Edwards
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia; Department of Medical Imaging, Redcliffe Hospital, Redcliffe, Australia.
| | - J Mitchell-Watson
- Medical Imaging and Nuclear Medicine, Queensland Children's Hospital, South Brisbane, Australia; Mob ED, Emergency Department, Queensland Children's Hospital, South Brisbane, Australia.
| | - J Yang
- School of Medicine, University of Queensland, St Lucia, Australia.
| | - T Reddan
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia; Medical Imaging and Nuclear Medicine, Queensland Children's Hospital, South Brisbane, Australia.
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Discepolo K, Melvin P, Ghazarians M, Tennermann N, Ward VL. Socioeconomic and Clinical Demography of Dental Missed Care Opportunities. JDR Clin Trans Res 2023; 8:356-366. [PMID: 35722931 DOI: 10.1177/23800844221104790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Missed care opportunities (MCOs) contribute to poor health outcomes, and pediatric dental patients are particularly vulnerable; identifying associated patient characteristics will help inform development of targeted interventional programs. OBJECTIVE To assess socioeconomic and demographic disparities associated with MCOs among children in an urban pediatric hospital's dental clinic. MCOs lead to a lack of continuous care and increased emergent needs, so understanding MCOs is required to achieve equitable pediatric dental health. METHODS A retrospective 2-y (2019-2020) cohort of MCOs in children 1 to 17 y old, with scheduled dental visits. MCOs were defined as appointments not attended or canceled and not rescheduled prior to initial scheduled visit. Multivariable mixed-effects logistic regression models with patient-level clustering assessed the associations of demographics, neighborhood-level socioeconomic factors (using social vulnerability index [SVI]), and clinic characteristics with MCOs. RESULTS Of 30,095 visits, 30.9% were MCOs. Multivariable logistic regression estimated increased likelihood of MCOs in Black/non-Hispanic (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.09-1.32) and Hispanic (OR, 1.18; 95% CI, 1.06-1.31) patients, patients with public insurance (OR, 1.25; 95% CI, 1.15-1.36) or no insurance (OR, 1.46; 95% CI, 1.15-1.85), patients with complex chronic conditions (OR, 1.11; 95% CI, 1.03-1.19), visits scheduled during the COVID-19 pandemic (OR, 9.48; 95% CI, 8.89-10.11), appointments with wait days over 21 d (OR, 4.07; 95% CI, 3.49-4.74), and children from neighborhoods of high social vulnerability (75th percentile SVI) (OR, 1.08; 95% CI, 1.01-1.16). CONCLUSIONS Children with highest dental MCOs were from neighborhoods with high SVI, had public insurance, and were from marginalized populations. MCOs contribute to inequities in overall health; hence, interventions that address barriers related to characteristics associated with pediatric dental MCOs are needed. KNOWLEDGE TRANSFER STATEMENT Missed care opportunities contribute to poor health outcomes; identifying associated patient characteristics will help inform development of targeted interventional programs. Providing these findings to stakeholders will better impart understanding access barriers and drive research and program development. Dissemination of this information in the form of altering appointment practices will better accommodate specific patient population needs.
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Affiliation(s)
- K Discepolo
- Department of Dentistry, Boston Children's Hospital, Boston, MA, USA
| | - P Melvin
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
| | - M Ghazarians
- Department of Dentistry, Boston Children's Hospital, Boston, MA, USA
| | - N Tennermann
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
| | - V L Ward
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Stegman MM, Lucarelli-Baldwin E, Ural SH. Disparities in high risk prenatal care adherence along racial and ethnic lines. Front Glob Womens Health 2023; 4:1151362. [PMID: 37560034 PMCID: PMC10407102 DOI: 10.3389/fgwh.2023.1151362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/10/2023] [Indexed: 08/11/2023] Open
Abstract
The term "high-risk pregnancy" describes a pregnancy at increased risk for complications due to various maternal or fetal medical, surgical, and/or anatomic issues. In order to best protect the pregnant patient and the fetus, frequent prenatal visits and monitoring are often recommended. Unfortunately, some patients are unable to attend these appointments for various reasons. Moreover, it has been documented that patients from ethnically and racially diverse backgrounds are more likely to miss medical appointments than are Caucasian patients. For instance, a case-control study retrospectively identified the race/ethnicity of patients who no-showed for mammography visits in 2018. Women who no-showed were more likely to be African American than patients who kept their appointments, with an odds ratio of 2.64 (4). Several other studies from several other primary care and specialty disciplines have shown similar results. However, the current research on high-risk obstetric no-shows has focused primarily on why patients miss their appointments rather than which patients are missing appointments. This is an area of opportunity for further research. Given disparities in health outcomes among underrepresented racial/ethnic groups and the importance of prenatal care, especially in high-risk populations, targeted attempts to increase patient participation in prenatal care may improve maternal and infant morbidity/mortality in these populations.
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Affiliation(s)
- Molly M Stegman
- College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Elizabeth Lucarelli-Baldwin
- Department of Obstetrics and Gynecology, College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Serdar H Ural
- Department of Obstetrics and Gynecology, College of Medicine, The Pennsylvania State University, Hershey, PA, United States
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Racial and ethnic disparities in pediatric magnetic resonance imaging missed care opportunities. Pediatr Radiol 2022; 52:1765-1775. [PMID: 35930081 DOI: 10.1007/s00247-022-05460-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/04/2022] [Accepted: 07/18/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Imaging missed care opportunities (MCOs), previously referred to as "no shows," impact timely patient diagnosis and treatment and can exacerbate health care disparities. Understanding factors associated with imaging MCOs could help advance pediatric health equity. OBJECTIVE To assess racial/ethnic differences in pediatric MR imaging MCOs and whether health system and socioeconomic factors, represented by a geography-based Social Vulnerability Index (SVI), influence racial/ethnic differences. MATERIALS AND METHODS We conducted a retrospective analysis of MR imaging MCOs in patients younger than 21 years at a pediatric academic medical center (2015-2019). MR imaging MCOs were defined as: scheduled but appointment not attended, canceled within 24 h, and canceled but not rescheduled. Mixed effects multivariable logistic regression assessed the association between MCOs and race/ethnicity and community-level social factors, represented by the SVI. RESULTS Of 68,809 scheduled MRIs, 6,159 (9.0%) were MCOs. A higher proportion of MCOs were among Black/African-American and Hispanic/Latino children. Multivariable analysis demonstrated increased odds of MCOs among Black/African-American (adjusted odds ratio [aOR] 1.9, 95% confidence interval [CI] 1.7-2.3) and Hispanic/Latino (aOR 1.5, 95% CI 1.3-1.7) children compared to White children. The addition of SVI >90th percentile to the adjusted model had no effect on adjusted OR for Black/African-American (aOR 1.9, 95% CI 1.7-2.2) or Hispanic/Latino (aOR 1.5, 95% CI 1.3-1.6) children. Living in a community with SVI >90th percentile was independently associated with MCOs. CONCLUSION Black/African-American and Hispanic/Latino children were almost twice as likely to experience MCOs, even when controlling for factors associated with MCOs. Independent of race/ethnicity, higher SVI was significantly associated with MCOs. Our study supports that pediatric health care providers must continue to identify systemic barriers to health care access for Black/African-American and Hispanic/Latino children and those from socially vulnerable areas.
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11
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Vera CD, Bogan K, Panigrahy A. Diversity, equity and inclusion in pediatric radiology: a minisymposium. Pediatr Radiol 2022; 52:1706-1707. [PMID: 35902423 PMCID: PMC9334548 DOI: 10.1007/s00247-022-05459-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 06/22/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Chido D Vera
- Department of Radiology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, One Children's Hospital Drive, 4401 Penn Ave., Pittsburgh, PA, 15224, USA
| | - Kristi Bogan
- Pediatric Interventional Radiology, Akron Children's Hospital, Akron, OH, USA
| | - Ashok Panigrahy
- Department of Radiology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, One Children's Hospital Drive, 4401 Penn Ave., Pittsburgh, PA, 15224, USA.
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