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Zebolsky AL, Gallo N, Clarke T, May JA, Dedhia RD, Eid A. Risk Factors for Missed Follow-up Appointments among Facial Trauma Patients. Facial Plast Surg 2024. [PMID: 38744423 DOI: 10.1055/a-2325-5425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
A retrospective case-control study was performed to characterize the rate of missed follow-up appointments after facial trauma and identify associated risk factors.Follow-up appointments for facial trauma over a 3-month period at a single, safety net hospital were analyzed. Appointment-specific, sociodemographic, trauma, and management data were compared between cases (missed appointments) and controls (attended appointments). Univariate testing and multivariable logistic regression were employed.A total of 116 cases and 259 controls were identified, yielding a missed appointment rate of 30.9% (116/375). Missed appointments were significantly associated with initial clinic appointments compared to return visits (odds ratio [OR] 2.21 [1.38-3.54]), afternoon visits compared to morning (OR 3.14 [1.94-5.07]), lack of private health insurance (OR 2.91 [1.68-5.18]), and presence of midface fractures (OR 2.04 [1.28-3.27]). Missed appointments were negatively associated with mandible fractures (OR 0.56 [0.35-0.89]), surgical management (OR 0.48 [0.30-0.77]), and the presence of nonremovable hardware (OR 0.39 [0.23-0.64]). Upon multivariable logistic regression, missed appointments remained independently associated with afternoon visits (adjusted OR [aOR] 1.95 [1.12-3.4]), lack of private health insurance (aOR 2.73 [1.55-4.8]), and midface fractures (aOR 2.09 [1.21-3.59]).Nearly one-third of facial trauma patients missed follow-up appointments, with the greatest risk among those with afternoon appointments, lacking private health insurance, and with midface fractures.
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Affiliation(s)
- Aaron L Zebolsky
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Nina Gallo
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Travis Clarke
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jeffery A May
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Raj D Dedhia
- Division of Facial Plastic Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Anas Eid
- Division of Facial Plastic Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
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Wilson CA, Jamil TL, Velu PS, Levi JR. Patient Factors Associated with Missed Otolaryngology Appointments at an Urban Safety-Net Hospital. Laryngoscope 2024. [PMID: 38602281 DOI: 10.1002/lary.31401] [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: 08/21/2023] [Revised: 02/21/2024] [Accepted: 03/13/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE To determine if patient factors related to ethnicity, socioeconomic status (SES), medical comorbidities, or appointment characteristics increase the risk of missing an initial adult otolaryngology appointment. METHODS This study is a retrospective case control study at Boston Medical Center (BMC) in Boston, Massachusetts, that took place in 2019. Patient demographic and medical comorbidity data as well as appointment characteristic data were collected and compared between those that attended their initial otolaryngology appointment versus those who missed their initial appointment. Chi-square and ANOVA tests were used to calculate differences between attendance outcomes. Multivariate analysis was used to compare the odds of missing an appointment based on various patient- and appointment-related factors. RESULTS Patients who were more likely to miss their appointments were more often female, of lower education, disabled, not employed, Black or Hispanic, and Spanish-speaking. Spring and Fall appointments were more likely to be missed. When a multivariate regression was conducted to control for social determinants of health (SDOH) such as race, insurance status, employment, and education status, the odds of females, Spanish-speaking, students, and disabled patients missing their appointment were no longer statistically significant. CONCLUSION A majority of patients at BMC come from lower SES backgrounds and have multiple medical comorbidities. Those who reside closer to BMC, often areas of lower average income, had higher rates of missed appointments. Interventions such as decreasing lag time, providing handicap-accessible free transportation, and increasing accessibility of telemedicine for patients could help improve attendance rates at BMC. LEVEL OF EVIDENCE IV Laryngoscope, 2024.
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Affiliation(s)
- Carolyn A Wilson
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, U.S.A
| | - Taylor L Jamil
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, U.S.A
- Boston University School of Public Health, Boston, Massachusetts, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, U.S.A
| | - Preetha S Velu
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, U.S.A
| | - Jessica R Levi
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, U.S.A
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Yuhan BT, Yasuda MA, Joshi R, Charous S, Hurtuk A. No-Show Rates in an Academic Otolaryngology Practice Before and During the COVID-19 Pandemic. Cureus 2024; 16:e54015. [PMID: 38476808 PMCID: PMC10929764 DOI: 10.7759/cureus.54015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE Our objectives were to determine the no-show and nonattendance rate for an outpatient academic otolaryngology practice, to identify patient and systemic factors associated with nonattendance, and to evaluate the impact that the COVID-19 pandemic had on the rate of nonattendance. METHODS This is a retrospective review of the Epic practice management and billing reports from all scheduled outpatient visits at a multi-physician, academic, general, and sub-specialty otolaryngology practice from January 2019 to December 2021. RESULTS Over three years, 121,347 clinic visits were scheduled in the otolaryngology practice. The overall nonattendance rate was 18.3%. A statistically significant increase in nonattendance was noted during the COVID-19 pandemic (16.8% vs. 19.8%, p < 0.001). The rate of nonattendance in patients of younger age (under 18 years) (p <0.001), female gender (p=0.03), afternoon appointments (p=0.04), and extended time between the day of scheduling and the day of appointment (p <0.001) increased. Head and neck clinics were found to have the lowest nonattendance rates, while pediatric otolaryngology clinics had the highest (12.6% vs. 21.3%). On multivariate regression, younger age (p < 0.001), female gender (p=0.01), afternoon appointments (p< 0.001), and online self-scheduling (p< 0.001) were significantly associated with nonattendance. CONCLUSIONS Both patient and appointment-related factors were found to impact rates of nonattendance in this academic otolaryngology practice. In this study, young age, female gender, afternoon appointments, and online self-scheduling were associated with increased nonattendance. In addition, the COVID-19 pandemic significantly impacted no-show rates across all otolaryngologic subspecialties.
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Affiliation(s)
- Brian T Yuhan
- Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, USA
| | - Mayuri A Yasuda
- Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, USA
| | - Radhika Joshi
- Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, USA
| | - Steven Charous
- Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, USA
| | - Agnes Hurtuk
- Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, USA
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Stanisce L, Ahmad N, Solomon DH, Kolia N, Garcia LD, Spalla TC, Gaughan JP, Koshkareva Y. Improving Outpatient Follow-Up Rates for New In-Hospital Consults. Laryngoscope 2023; 133:2540-2545. [PMID: 36511340 DOI: 10.1002/lary.30519] [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: 10/04/2022] [Revised: 11/08/2022] [Accepted: 11/27/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE(S) This investigation aimed to define the rate of outpatient follow-up after in-hospital consultation, identify factors associated with establishing care, and evaluate an alternative scheduling process to improve outpatient adherence. METHODS Two-phase, prospective study at an academic, tertiary-care institution from March 2020 to August 2022. First, all patients not previously known to our practice encountered via inpatient consult who warranted outpatient follow-up were prospectively captured. Logistic regression analysis was used to identify demographic, disease, and practice factors predictive of follow-up. Second, a randomized control trial was performed to validate the effects of pre-assigning appointments prior to discharge. RESULTS Six hundred subjects were included in the final study cohort; 500 in phase-one, and 100 randomized during phase-two. In the phase-one cohort, 54% (n = 272) were lost to follow-up. Multivariate analysis showed increased odds of outpatient follow-up when appointments were pre-assigned before discharge (odds ratio [OR]: 3.69 [95% confidence interval [CI]: 2.29-5.96], p < 0.001), the primary reason for hospitalization was ENT and consult-related (OR: 3.29 [1.92-5.64], p < 0.001), and the diagnosis was one of Oncology (OR: 1.93 [1.02-3.69], p = 0.045) or Pediatrics (OR: 3.36 [1.41-7.98], p = 0.006) subspecialties. During phase-two, subjects randomized for pre-assigned appointments had higher outpatient follow-up (82%) compared to the control group (20%) (p < 0.001). CONCLUSION Hospital-based consultations represent an important referral pathway for new patients. Disease characteristics may identify patients less likely to follow-up upon discharge. Appointment scheduling protocols, including pre-assigning appointments, are modifiable targets for improving adherence to care. Laryngoscope, 133:2540-2545, 2023.
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Affiliation(s)
- Luke Stanisce
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - Nadir Ahmad
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - Donald H Solomon
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - Nadeem Kolia
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - Lucia D Garcia
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - Thomas C Spalla
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - John P Gaughan
- Cooper Research Institute, Cooper University Health Care, Camden, New Jersey, U.S.A
| | - Yekaterina Koshkareva
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, U.S.A
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Naimi B, Agarwal P, Ma H, Levi JR. Association between no-show rates and interpreter use in a pediatric otolaryngology clinic. Int J Pediatr Otorhinolaryngol 2023; 172:111663. [PMID: 37506576 DOI: 10.1016/j.ijporl.2023.111663] [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: 03/15/2023] [Revised: 07/06/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVES To understand how primary language and interpreter use affect no-show rates in pediatric otolaryngology. METHODS This is a retrospective cohort study using medical records of new patients in a pediatric otolaryngology clinic from 2014 to 2019. Data was collected on patient demographics including age, primary language, insurance type, maternal education level, maternal primary language, interpreter use at the first visit, total number of appointments scheduled, number of missed appointments, and number of completed appointments. Inferential statistics using parametric (ANOVA) and non-parametric (Mann-Whitney U tests, Kruskal-Wallis tests, and Spearman correlation coefficient) methods were used. RESULTS Primary language was associated with significant differences in no-show rates (p = 0.0474), with Spanish and English speakers having the lowest no-show rate (33%). Overall, interpreter use at the first visit was not significantly associated with subsequent appointment attendance (p = 0.3674). Patients with a documented Spanish interpreter at the first visit had the lowest average no-show rate (31% ± 19%) compared to Haitian Creole (42% ± 18%) and all other languages (32% ± 19%) (p = 0.0265). Hispanic ethnicity, maternal education level, and maternal primary language were not associated with attendance. CONCLUSION Interpreter use at the first visit was not significantly correlated with no-show rates, but among patients that did require an interpreter at the first visit, those receiving services in Spanish had the best clinic attendance.
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Affiliation(s)
- Bita Naimi
- Boston University School of Medicine, Department of Otolaryngology, Boston, MA, USA.
| | - Pratima Agarwal
- Boston Medical Center, Department of Otolaryngology, Boston, MA, USA
| | - Haoxi Ma
- University of Connecticut, Department of Statistics, Storrs, CT, USA
| | - Jessica R Levi
- Boston University School of Medicine, Department of Otolaryngology, Boston, MA, USA; Boston Medical Center, Department of Otolaryngology, Boston, MA, USA
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Chen K, Zhang C, Gurley A, Akkem S, Jackson H. Appointment Non-attendance for Telehealth Versus In-Person Primary Care Visits at a Large Public Healthcare System. J Gen Intern Med 2023; 38:922-928. [PMID: 36220946 PMCID: PMC9552719 DOI: 10.1007/s11606-022-07814-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/14/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Appointment non-attendance has clinical, operational, and financial implications for patients and health systems. How telehealth services are associated with non-attendance in primary care is not well-described, nor are patient characteristics associated with telehealth non-attendance. OBJECTIVE We sought to compare primary care non-attendance for telehealth versus in-person visits and describe patient characteristics associated with telehealth non-attendance. DESIGN An observational study of electronic health record data. PARTICIPANTS Patients with primary care encounters at 23 adult primary care clinics at a large, urban public healthcare system from November 1, 2019, to August 31, 2021. MAIN MEASURES We analyzed non-attendance by modality (telephone, video, in-person) during three time periods representing different availability of telehealth using hierarchal multiple logistic regression to control for patient demographics and variation within patients and clinics. We stratified by modality and used hierarchal multiple logistic regression to assess for associations between patient characteristics and non-attendance in each modality. KEY RESULTS There were 1,219,781 scheduled adult primary care visits by 329,461 unique patients: 754,149 (61.8%) in-person, 439,295 (36.0%) telephonic, and 26,337 (2.2%) video visits. Non-attendance for telephone visits was initially higher than that for in-person visits (adjusted odds ratio 1.04 [95% CI 1.02, 1.07]) during the early telehealth availability period, but decreased later (0.82 [0.81, 0.83]). Non-attendance for video visits was higher than for in-person visits during the early (4.37 [2.74, 6.97]) and later (2.02 [1.95, 2.08]) periods. Telephone visits had fewer differences in non-attendance by demographics; video visits were associated with increased non-attendance for patients who were older, male, had a primary language other than English or Spanish, and had public or no insurance. CONCLUSIONS Telephonic visits may improve access to care and be more easily adoptable among diverse populations. Further attention to implementation may be needed to avoid impeding access to care for certain populations using video visits.
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Affiliation(s)
- Kevin Chen
- New York City Health + Hospitals, New York, NY, USA.
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA.
| | | | | | - Shashi Akkem
- New York City Health + Hospitals, New York, NY, USA
| | - Hannah Jackson
- New York City Health + Hospitals, New York, NY, USA
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
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Predictors of No-Show in Neurology Clinics. Healthcare (Basel) 2022; 10:healthcare10040599. [PMID: 35455777 PMCID: PMC9025597 DOI: 10.3390/healthcare10040599] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/09/2022] [Accepted: 03/16/2022] [Indexed: 02/04/2023] Open
Abstract
In this study, we aim to identify predictors of a no-show in neurology clinics at our institution. We conducted a retrospective review of neurology clinics from July 2013 through September 2018. We compared odds ratio of patients who missed appointments (no-show) to those who were present at appointments (show) in terms of age, lead-time, subspecialty, race, gender, quarter of the year, insurance type, and distance from hospital. There were 60,012 (84%) show and 11,166 (16%) no-show patients. With each day increase in lead time, odds of no-show increased by a factor of 1.0019 (p < 0.0001). Odds of no-show were higher in younger (p ≤ 0.0001, OR = 0.49) compared to older (age ≥ 60) patients and in women (p < 0.001, OR = 1.1352) compared to men. They were higher in Black/African American (p < 0.0001, OR = 1.4712) and lower in Asian (p = 0.03, OR = 0.6871) and American Indian/Alaskan Native (p = 0.055, OR = 0.6318) as compared to White/Caucasian. Patients with Medicare (p < 0.0001, OR = 1.5127) and Medicaid (p < 0.0001, OR = 1.3354) had higher odds of no-show compared to other insurance. Young age, female, Black/African American, long lead time to clinic appointments, Medicaid/Medicare insurance, and certain subspecialties (resident and stroke clinics) are associated with high odds of no show. Possible suggested interventions include better communication and flexible appointments for the high-risk groups as well as utilizing telemedicine.
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Soh HH, Keefe KR, Sambhu M, Baul TD, Karst DB, Levi JR. Factors Affecting Compliance With Myringotomy Tube Follow-up Care. Ann Otol Rhinol Laryngol 2022; 131:1333-1339. [PMID: 35016528 DOI: 10.1177/00034894211072293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Myringotomy and tube insertion is a commonly practiced procedure within pediatric otolaryngology. Though relatively safe, follow-up appointments are critical in preventing further complications and monitoring for improvement. This study sought to evaluate the factors associated with compliance of post-myringotomy follow-up visits in an urban safety-net tertiary care setting. METHODS This study is a retrospective chart review conducted in outpatient otolaryngology clinic at an urban, safety-net, tertiary-care, academic medical center. All patients from ages 0 to 18 who received myringotomy and tube placement between February 3, 2012, to May 30, 2018 at the aforementioned clinic were included. RESULTS A total of 806 patients had myringotomy tubes placed during this period; 190 patients were excluded due to no visits being scheduled within 1 and 6 month visit windows post-operatively, leaving 616 patients included for analysis. Of 616 patients, 574 patients were seen for the 1-month visit, (42 patients did not have follow-up visits within the 1-month window), and 356 patients were examined for the 6-month visit (260 patients did not schedule follow-up visits within the 6-month window). For the 1-month follow-up visits post-procedure, only race/ethnicity type "Other" was associated with lower no-show rates (OR = 0.330, 95% CI: 0.093-0.968). With the 6-month follow-up visits, having private insurance (OR = 0.446, 95% CI: 0.229-0.867) and not having a 1-month visit scheduled (OR = 0.404, 95% CI: 0.174-0.937) predicted lower no-show rates. CONCLUSION No meaningful factors studied were significantly associated with compliance of short-term, 1-month visits post-myringotomy. Compliance of longer-term, 6-month post-operative visits was associated with insurance type and previous visit status.
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Affiliation(s)
- Helen H Soh
- Boston University School of Medicine, Boston, MA, USA
| | - Katherine R Keefe
- Department of Otolaryngology, University of Utah, Salt Lake City, UT, USA
| | - Madhav Sambhu
- Boston University School of Medicine, Boston, MA, USA
| | - Tithi D Baul
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | | | - Jessica R Levi
- Department of Otolaryngology, Boston Medical Center, Boston, MA, USA
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Brodie KD, Fakurnejad S, Czechowicz JA, Nadaraja GS. Associations between demographic factors and pediatric otolaryngology access disparities in the COVID-19 era. Int J Pediatr Otorhinolaryngol 2022; 152:110971. [PMID: 34782175 PMCID: PMC9754654 DOI: 10.1016/j.ijporl.2021.110971] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To assess the impact of demographic factors and telehealth on access to pediatric otolaryngology care during the COVID-19 pandemic, as measured by attendance. METHODS Retrospective, observational study of all referrals to pediatric otolaryngology at a single, tertiary care pediatric hospital system in the US. All referrals placed to pediatric otolaryngology from March through December 2020 were compared with referrals between March and December 2019. Data on patient demographics, date of referral, duration between referral and appointment, appointment type, and diagnosis acuity were collected. A multivariate linear regression was used to evaluate the impact of the patient age, ethnicity, language, insurance, diagnosis acuity, time to appointment, and appointment type on attendance. RESULTS This study included 1988 referrals placed between March 16th-December 31st, 2020 and 3704 referrals placed between March 16th-December 31st, 2019. In 2020, attendance proportions were significantly higher at 72% compared to 62% during 2019 (p < 0.001). In 2020, there was a significantly shorter duration between referral and appointment, averaging 10 days as compared to 26 days in 2019 (p < 0.001). Overall, Black and Hispanic patients, children over the age of one, publicly insured patients, and those with longer wait times were less likely to attend their appointments. Primary language and use of telehealth did not predict attendance. CONCLUSION Early evidence has found significant healthcare access and outcome disparities across ethnicities during the COVID pandemic. However, there is limited data evaluating the effect of demographic factors or telehealth on access to pediatric otolaryngology care. This study identifies age, race and insurance type as predictors of access to pediatric otolaryngologic care, as measured by attendance.
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Affiliation(s)
| | - Shayan Fakurnejad
- Department of Otolaryngology, Head and Neck Surgery, University of California, San Francisco, USA.
| | | | - Garani S. Nadaraja
- Corresponding author. 2233 Post Street, 3rd Floor, Box 1225, San Francisco, CA, USA
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Chiam M, Kunselman AR, Chen MC. Characteristics Associated With New Patient Appointment No-Shows at an Academic Ophthalmology Department in the United States. Am J Ophthalmol 2021; 229:210-219. [PMID: 33626367 DOI: 10.1016/j.ajo.2021.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/29/2021] [Accepted: 02/16/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE This study aimed to identify patient and appointment characteristics associated with no-shows to new patient appointments at a US academic ophthalmology department. DESIGN Cross-sectional study. METHODS This was a study of all adult patients with new patient appointments scheduled with an attending ophthalmologist at Penn State Eye Center between January 1st and December 31st of 2019. A multiple logistic regression model was used to assess the association between characteristics and no-show status. RESULTS Of 4,628 patients, 759 (16.4%) were no-shows. From the multiple logistic regression model, characteristics associated with no-shows were age (Odds Ratio (OR) for 18-40 years vs. >60 years: 3.41, 95% Confidence Interval (CI) 2.57, 4.51, p <0.001 and OR for 41-60 years vs. >60 years: 2.14, 95% CI 1.67, 2.74, p<0.001), median household income (OR for <$35,667 vs. >$59,445: 1.59, 95% CI 1.08, 2.34, p<0.001), insurance (OR for None vs. Medicare: 6.92, 95% CI 4.41, 10.86, p<0.001 and OR for Medicaid vs. Medicare: 1.54, 95% CI 1.18, 2.01, p=0.002), race (OR for Black vs. White: 2.62, 95% CI 2.00, 3.43, p<0.001 and OR for Other vs. White: 2.02, 95% CI 1.58, 2.59, p<0.001), and commute distance (OR for 5-10 mi vs. ≤5 mi: 1.73, 95% CI 1.17, 2.55, p=0.006). Appointments with longer lead times and scheduled with glaucoma or retina specialists were also significantly associated with greater no-shows. CONCLUSION Certain patient and appointment characteristics were associated with no-show status. These findings may assist in the development of targeted interventions at the patient, practice, and health system levels to improve appointment attendance.
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Affiliation(s)
- Mckenzee Chiam
- From the Department of Ophthalmology (MC, MCC), Pennsylvania State College of Medicine, Hershey, Pennsylvania, USA
| | - Allen R Kunselman
- Department of Public Health Sciences (ARK), Pennsylvania State College of Medicine, Hershey, Pennsylvania, USA
| | - Michael C Chen
- From the Department of Ophthalmology (MC, MCC), Pennsylvania State College of Medicine, Hershey, Pennsylvania, USA.
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Bhavsar NA, Doerfler SM, Giczewska A, Alhanti B, Lutz A, Thigpen CA, George SZ. Prevalence and predictors of no-shows to physical therapy for musculoskeletal conditions. PLoS One 2021; 16:e0251336. [PMID: 34048440 PMCID: PMC8162651 DOI: 10.1371/journal.pone.0251336] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/23/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Chronic pain affects 50 million Americans and is often treated with non-pharmacologic approaches like physical therapy. Developing a no-show prediction model for individuals seeking physical therapy care for musculoskeletal conditions has several benefits including enhancement of workforce efficiency without growing the existing provider pool, delivering guideline adherent care, and identifying those that may benefit from telehealth. The objective of this paper was to quantify the national prevalence of no-shows for patients seeking physical therapy care and to identify individual and organizational factors predicting whether a patient will be a no-show when seeking physical therapy care. DESIGN Retrospective cohort study. SETTING Commercial provider of physical therapy within the United States with 828 clinics across 26 states. PARTICIPANTS Adolescent and adult patients (age cutoffs: 14-117 years) seeking non-pharmacological treatment for musculoskeletal conditions from January 1, 2016, to December 31, 2017 (n = 542,685). Exclusion criteria were a primary complaint not considered an MSK condition or improbable values for height, weight, or body mass index values. The study included 444,995 individuals. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence of no-shows for musculoskeletal conditions and predictors of patient no-show. RESULTS In our population, 73% missed at least 1 appointment for a given physical therapy care episode. Our model had moderate discrimination for no-shows (c-statistic:0.72, all appointments; 0.73, first 7 appointments) and was well calibrated, with predicted and observed no-shows in good agreement. Variables predicting higher no-show rates included insurance type; smoking-status; higher BMI; and more prior cancellations, time between visit and scheduling date, and between current and previous visit. CONCLUSIONS The high prevalence of no-shows when seeking care for musculoskeletal conditions from physical therapists highlights an inefficiency that, unaddressed, could limit delivery of guideline-adherent care that advocates for earlier use of non-pharmacological treatments for musculoskeletal conditions and result in missed opportunities for using telehealth to deliver physical therapy.
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Affiliation(s)
- Nrupen A. Bhavsar
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United Stated of America
| | - Shannon M. Doerfler
- Duke Clinical Research Institute, Duke University, Durham, NC, United Stated of America
| | - Anna Giczewska
- Duke Clinical Research Institute, Duke University, Durham, NC, United Stated of America
| | - Brooke Alhanti
- Duke Clinical Research Institute, Duke University, Durham, NC, United Stated of America
| | - Adam Lutz
- ATI Physical Therapy, Greenville, SC, United Stated of America
- Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United Stated of America
| | - Charles A. Thigpen
- ATI Physical Therapy, Greenville, SC, United Stated of America
- Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United Stated of America
- Center for Effectiveness Research in Orthopaedics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United Stated of America
| | - Steven Z. George
- Duke Clinical Research Institute, Duke University, Durham, NC, United Stated of America
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United Stated of America
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12
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Deledda G, Riccardi N, Gori S, Poli S, Giansante M, Geccherle E, Mazzi C, Silva R, Desantis N, Giovannetti AM, Solari A, Confalonieri P, Grazzi L, Sarcletti E, Biffa G, Biagio AD, Sestito C, Keim R, Gangi Hermis AMRD, Mazzoldi M, Failo A, Scaglione A, Faldetta N, Dorangricchia P, Moschetto M, Soto Parra HJ, Faietti J, Profio AD, Rusconi S, Giacomelli A, Marchioretto F, Alongi F, Marchetta A, Molon G, Bisoffi Z, Angheben A. The Impact of the SARS-CoV-2 Outbreak on the Psychological Flexibility and Behaviour of Cancelling Medical Appointments of Italian Patients with Pre-Existing Medical Condition: The "ImpACT-COVID-19 for Patients" Multi-Centre Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E340. [PMID: 33466374 PMCID: PMC7794735 DOI: 10.3390/ijerph18010340] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/24/2020] [Accepted: 12/29/2020] [Indexed: 12/13/2022]
Abstract
Psychological distress imposed by the SARS-CoV-2 outbreak particularly affects patients with pre-existing medical conditions, and the progression of their diseases. Patients who fail to keep scheduled medical appointments experience a negative impact on care. The aim of this study is to investigate the psychosocial factors contributing to the cancellation of medical appointments during the pandemic by patients with pre-existing health conditions. Data were collected in eleven Italian hospitals during the last week of lockdown, and one month later. In order to assess the emotional impact of the SARS-CoV-2 outbreak and the subject's degree of psychological flexibility, we developed an ad hoc questionnaire (ImpACT), referring to the Acceptance and Commitment Therapy (ACT) model. The Impact of Event Scale-Revised (IES-R), the Depression, Anxiety and Stress Scale (DASS) and the Cognitive Fusion Questionnaire (CFQ) were also used. Pervasive dysfunctional use of experiential avoidance behaviours (used with the function to avoid thought, emotions, sensations), feelings of loneliness and high post-traumatic stress scores were found to correlate with the fear of COVID-19, increasing the likelihood of cancelling medical appointments. Responding promptly to the information and psychological needs of patients who cancel medical appointments can have positive effects in terms of psychological and physical health.
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Affiliation(s)
- Giuseppe Deledda
- Clinical Psychology Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy; (S.P.); (M.G.); (E.G.)
| | - Niccolò Riccardi
- Department of Infectious—Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy; (N.R.); (Z.B.); (A.A.)
| | - Stefania Gori
- Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024 Verona, Italy;
| | - Sara Poli
- Clinical Psychology Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy; (S.P.); (M.G.); (E.G.)
| | - Matteo Giansante
- Clinical Psychology Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy; (S.P.); (M.G.); (E.G.)
| | - Eleonora Geccherle
- Clinical Psychology Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy; (S.P.); (M.G.); (E.G.)
| | - Cristina Mazzi
- Clinical Research Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy; (C.M.); (R.S.); (N.D.)
| | - Ronaldo Silva
- Clinical Research Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy; (C.M.); (R.S.); (N.D.)
| | - Nicoletta Desantis
- Clinical Research Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy; (C.M.); (R.S.); (N.D.)
| | - Ambra Mara Giovannetti
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20145 Milan, Italy; (A.M.G.); (A.S.)
- Multiple Sclerosis Centre, Neuroimmunology Unit, Clinical Neurology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20145 Milan, Italy;
- School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, 4072 QLD, Australia
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20145 Milan, Italy; (A.M.G.); (A.S.)
| | - Paolo Confalonieri
- Multiple Sclerosis Centre, Neuroimmunology Unit, Clinical Neurology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20145 Milan, Italy;
| | - Licia Grazzi
- Headache Center, Neurology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20145 Milan, Italy;
| | - Elena Sarcletti
- Clinical Psychology and Psychotherapy Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (E.S.); (G.B.)
| | - Gabriella Biffa
- Clinical Psychology and Psychotherapy Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (E.S.); (G.B.)
| | - Antonio Di Biagio
- Infectious Diseases Clinic, Policlinico San Martino Hospital-IRCCS, 16132 Genoa, Italy;
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, 16132 Genoa, Italy
| | - Carlo Sestito
- Service of Psycho Oncology, San Giovanni di Dio Hospital, Azienda Sanitaria Provinciale di Crotone, 88900 Crotone, Italy;
| | - Roland Keim
- General Hospital Bressanone, Azienda Sanitaria dell’Alto Adige, Bressanone, 39042 Bolzano, Italy; (R.K.); (A.M.R.D.G.H.)
| | - Alida M. R. Di Gangi Hermis
- General Hospital Bressanone, Azienda Sanitaria dell’Alto Adige, Bressanone, 39042 Bolzano, Italy; (R.K.); (A.M.R.D.G.H.)
| | - Mariantonietta Mazzoldi
- General Hospital Bolzano Azienda Sanitaria dell’Alto Adige, 39100 Bolzano, Italy; (M.M.); (A.F.)
| | - Alessandro Failo
- General Hospital Bolzano Azienda Sanitaria dell’Alto Adige, 39100 Bolzano, Italy; (M.M.); (A.F.)
| | - Anna Scaglione
- CFU-Italia ODV (Fybromyalgia Association), Castenaso, 40085 Bologna, Italy;
| | - Naida Faldetta
- Department of Oncoplastic Surgery of Breast Unit. V. Cervello Hospital, 90100 Palermo, Italy; (N.F.); (P.D.)
| | - Patrizia Dorangricchia
- Department of Oncoplastic Surgery of Breast Unit. V. Cervello Hospital, 90100 Palermo, Italy; (N.F.); (P.D.)
| | - Maria Moschetto
- Oncology Unit, Azienda Ospedaliero Universitaria (A.O.U.) Policlinico Vittorio Emanuele, 95123 Catania, Italy; (M.M.); (H.J.S.P.)
| | - Hector Josè Soto Parra
- Oncology Unit, Azienda Ospedaliero Universitaria (A.O.U.) Policlinico Vittorio Emanuele, 95123 Catania, Italy; (M.M.); (H.J.S.P.)
| | - Jennifer Faietti
- Cardiac Surgery Unit, Salus Hospital GVM Care & Research, 42123 Regio Emilia, Italy;
| | - Anna Di Profio
- Clinical Oncology Unit, S.S. Annunziata Hospital, 66100 Chieti, Italy;
| | - Stefano Rusconi
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences (DIBIC) Luigi Sacco, University of Milan, 20157 Milan, Italy; (S.R.); (A.G.)
| | - Andrea Giacomelli
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences (DIBIC) Luigi Sacco, University of Milan, 20157 Milan, Italy; (S.R.); (A.G.)
| | - Fabio Marchioretto
- Neurological Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy;
| | - Filippo Alongi
- Advanced Radiation Oncology Department, Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy;
- University of Brescia, 25121 Brescia, Italy
| | - Antonio Marchetta
- Rheumatology Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy;
| | - Giulio Molon
- Cardiology Deparment, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy;
| | - Zeno Bisoffi
- Department of Infectious—Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy; (N.R.); (Z.B.); (A.A.)
| | - Andrea Angheben
- Department of Infectious—Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy; (N.R.); (Z.B.); (A.A.)
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