Strategies to Reduce Missed Appointments in Pediatric Radiology
Key findings
- This study assessed whether specific socioeconomic factors and imaging exam characteristics were associated with an increased likelihood of missed appointments among children scheduled for diagnostic imaging
- Of 7,275 appointments analyzed, 8.2% were missed
- The likelihood of missed appointments was significantly associated with Black/African-American race; Medicaid, self-pay and other non-commercial insurance; and living in a ZIP code associated with <$50,000 median household income
- Other factors associated with missed appointments were fluoroscopy imaging modality and wait time of ≥7 days between the date the examination was ordered and the date it was scheduled to be performed
- Factors associated with significantly decreased likelihood of missed appointments were $100,000+ median household income by ZIP code and MR imaging modality
Because of their longer life expectancy, children stand to gain more from timely access to health care than adults do over the long term—and suffer more from suboptimal care. Missed appointments are one example of suboptimal care, and understanding the risk factors for missed pediatric radiology appointments can help clinics improve access for all children.
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Efrén J. Flores, MD, an officer of Radiology Community Health Improvement and Equity in the Department of Radiology at Massachusetts General Hospital, and Dania Daye, MD, PhD, Physician-Scientist at the Martinos Center for Biomedical Imaging at Mass General, and colleagues have linked certain socioeconomic factors and imaging exam characteristics to an increased likelihood of missed appointments among children. They give the details in Pediatric Radiology.
Study Methods
The researchers analyzed 7,275 outpatient diagnostic imaging studies for pediatric patients who required appointments. The procedures (CT, MRI, ultrasound, fluoroscopy and nuclear medicine) were scheduled at Mass General between April 1, 2015, and March 30, 2016.
The average patient age was 8.8 years and the age distribution was:
- Infants (<2 years): 25%
- Toddlers (3–5 years): 9%
- Elementary school (6–12 years): 28%
- Adolescents (13–17 years): 38%
Frequency of Missed Appointments
The overall rate of missed appointments was 8.2%. Studies of adults have estimated a rate of 2% to 6.5%, depending on imaging modality. The difference is probably attributable to the fact that most pediatric patients are dependent on their caregivers to bring them to appointments.
Risk Factors
In multivariate analysis, the factors significantly associated with increased likelihood of missed appointments were:
- Wait time of >21 days (OR=3.7)
- Wait time of 7–21 days (OR=2.7)
- Medicaid (OR=2.0)
- Self-pay (OR=2.1)
- "Other" insurance categories besides commercial insurance (OR=2.7)
- Black/African-American race (OR=1.9)
- <$50,000 median household income by ZIP code (OR=1.7)
- Fluoroscopy imaging modality (OR=1.5)
Factors associated with a significantly decreased likelihood of missed appointments were $100,000+ median household income by ZIP code (OR=0.7) and MR imaging modality (OR=0.4).
The planned use of radiation, intravenous contrast agent or sedation were analyzed but were not associated with an increased likelihood of missed appointments.
Potential Strategies for Improvement
To reduce wait time:
- Add routine weekend and evening appointments for diagnostic imaging
- Improve coordination with other medical appointments
To address financial barriers:
- Increase cost transparency and ask caregivers if they have cost concerns that might prevent them from pursuing imaging for their children
- Collaborate with health care institutions that help children and their caregivers access financial resources; this might include online portals to government programs and private groups, such as Aunt Bertha, that offer support
To improve access for toddlers:
- Employ child life specialists to educate children and their caregivers about the upcoming appointment and address any concerns
- Collaborate with referring providers and community health care workers to help alleviate uncertainty and potential concerns
General suggestions—adopt strategies used to reduce missed appointments for well-child visits:
- Educate the patient's caregivers about the benefits of completed appointments
- Track missed appointments and document the reason(s)
- Update the child's caregiver contact information at every visit
- Provide walk-in slots to accommodate children with high rates of missed appointments
Finally, consider replacing the term "no-show." A less pejorative term, "missed care opportunity," takes into account how social determinants of health may prevent patients from engaging with their care. Individual radiologists and the health care system have a role in population health to facilitate access to medical appointments.
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