Measuring the Barriers to Adherence With Neurology Clinic Appointments for Children With Epilepsy: A Pilot Study

Bailey, Jason A.; West, Melanie; Agarwal, Rashmi; Kumar, Gogi

doi:10.1177/2329048x211012544

Cited by 10 publications

(6 citation statements)

References 37 publications

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“…19,20 Many factors including economic and logistic factors, mistrust in the health care system, and systemic racism have been attributed to these differences. 10,14,28–30 In our study, audio visits reduced the odds of missed appointments for all children; this association was more pronounced for children of Black race. Similar moderating effect was not seen with video visits.…”

Section: Discussionsupporting

confidence: 43%

Audio or Video? Access to Pediatric Neurology Outpatient Services Varies by the Type of Telehealth, Especially for Black Children

Grefe

Chen

et al. 2023

J Child Neurol

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Background Children of minority race/ethnicity face barriers to accessing specialty services. During the COVID pandemic, health insurance companies reimbursed telehealth services. Our objective was to evaluate the effect of audio versus video visits on children's access to outpatient neurology services, particularly for Black children. Methods Using Electronic Health Record data, we collected information about children who had outpatient neurology appointments in a tertiary care children's hospital in North Carolina from March 10, 2020, to March 9, 2021. We used multivariable models to compare appointment outcomes (canceled vs completed, and missed vs completed) by visit type. We then conducted similar evaluation for the subgroup of Black children. Results A total of 1250 children accounted for 3829 scheduled appointments. Audio users were more likely to be Black and Hispanic, and to have public health insurance than video users. Adjusted odds ratio (aOR) for appointments completed versus canceled was 10 for audio and 6 for video, compared to in-person appointments. Audio visits were twice as likely as in-person visits to be completed versus missed; video visits were not different. For the subgroup of Black children, aOR for appointments completed versus canceled for audio was 9 and video was 5, compared to in-person appointments. For Black children, audio visits were 3 times as likely as in-person visits to be completed versus missed; video visits were not different. Conclusions Audio visits improved access to pediatric neurology services, especially for Black children. Reversal of policies to reimburse audio visits could deepen the socioeconomic divide for children's access to neurology services.

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Section: Discussionsupporting

confidence: 43%

Audio or Video? Access to Pediatric Neurology Outpatient Services Varies by the Type of Telehealth, Especially for Black Children

Grefe

Chen

et al. 2023

J Child Neurol

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“…They also demonstrated a link between missed appointments and increased emergency department visits related to seizures. 7 However, they did not utilize predictive analytics to prospectively determine the likelihood of missing a scheduled appointment. The factors around insurance status deserve more attention to determine specific barriers that lead to missed patient appointments.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

“…6 A recent study reported that children with epilepsy who had a higher number of previous no-shows to a pediatric neurology clinic visit had a higher frequency of emergency department visits and a 6 times higher likelihood of inpatient hospitalizations related to seizures. 7 Interventions developed to reduce no-shows must overcome barriers to attending the clinic appointment. One such intervention could involve having staff personally call every patient before their appointments to identify the obstacles and connect them with the resources needed to attend an appointment.…”

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confidence: 99%

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Predicting Patient No-Shows in an Academic Pediatric Neurology Clinic

et al. 2022

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Background: No-shows can negatively affect patient care. Efforts to predict high-risk patients are needed. Previously, our epilepsy clinic identified patients with 2 or more no-shows or late cancelations in the past 18 months as being at high risk for no-shows. Our objective was to develop a model to accurately predict the risk of no-shows among patients with epilepsy seen at our neurology clinic. Methods: Using electronic health record data, we developed a least absolute shrinkage and selection operator (LASSO)–regularized logistic regression model to predict no-shows and compared its performance with our neurology clinic's above-mentioned ad hoc rule. Results: The ad hoc rule identified 13% of patients seen at our neurology clinic as high-risk patients for no-shows and resulted in a positive predictive value of 38%. In comparison, our LASSO model resulted in a positive predictive value of 48%. Our LASSO model identified that lack of private insurance, inactive Epic MyChart, greater past no-show rates, fewer appointment changes before the appointment date, and follow-up appointments were more likely to result in no-shows. Conclusions: Our LASSO model outperformed the ad hoc rule used by our neurology clinic in predicting patients at high risk for no-shows. Social workers can use the no-show risk scores generated by our LASSO model to prioritize high-risk patients for targeted intervention to reduce no-shows at our neurology clinic.

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“…Nonattendance leads to higher health care costs and further decreases access to subspecialty care, while potentially compromising patient safety. [13][14][15][16] Numerous studies have evaluated referral communication processes between PCPs and subspecialists as well as appropriate reasons for referral. [17][18][19][20] But less is known about why patients fail to complete subspecialty referrals, particularly in pediatrics.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Subspecialty Appointment Scheduling and Completion for Patients Referred From a Pediatric Primary Care Clinic

Rea

Toomey

Hauptman

et al. 2023

Clin Pediatr (Phila)

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Failure to complete subspecialty referrals decreases access to subspecialty care and may endanger patient safety. We conducted a retrospective analysis of new patient referrals made to the 14 most common referral departments at Boston Children’s Hospital from January 1 to December 31, 2017. The sample included 2031 patient referrals. The mean wait time between referral and appointment date was 39.6 days. In all, 87% of referrals were scheduled and 84% of scheduled appointments attended, thus 73% of the original referrals were completed. In multivariate analysis, younger age, medical complexity, being a non-English speaker, and referral to a surgical subspecialty were associated with a higher likelihood of referral completion. Black and Hispanic/Latino race/ethnicity, living in a Census tract with Social Vulnerability Index (SVI) ≥ 90th percentile, and longer wait times were associated with a lower likelihood of appointment attendance. Future interventions should consider both health care system factors such as appointment wait times and community-level barriers to referral completion.

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Measuring the Barriers to Adherence With Neurology Clinic Appointments for Children With Epilepsy: A Pilot Study

Cited by 10 publications

References 37 publications

Audio or Video? Access to Pediatric Neurology Outpatient Services Varies by the Type of Telehealth, Especially for Black Children

Audio or Video? Access to Pediatric Neurology Outpatient Services Varies by the Type of Telehealth, Especially for Black Children

Predicting Patient No-Shows in an Academic Pediatric Neurology Clinic

Predictors of Subspecialty Appointment Scheduling and Completion for Patients Referred From a Pediatric Primary Care Clinic

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