J Healthc Qual. 2022;44(4):230-239. doi: 10.1097/JHQ.0000000000000341. Epub 2022 Mar 17.
Missed appointments negatively affect patients, providers, and health systems. This study aimed to (1) quantify the percentage of missed appointments across 14 pediatric subspecialties in a tertiary-care children's hospital and (2) identify patient characteristics associated with missed appointments in those subspecialties.
We extracted patient characteristics from 267,151 outpatient appointments, between January 1, 2013, and December 31, 2018, across 14 subspecialty clinics. Medical complexity was categorized using the Pediatric Medical Complexity Algorithm. The primary outcome was appointment nonattendance. Cancellations, imaging/laboratory visits, patients older than 18 years, and duplicate visits were excluded. Characteristics associated with nonattendance were analyzed with chi-square tests and included in the multivariable model if p < .1. Missing data were addressed using random forest imputation, and assuming data were "missing at random." Variables were considered statistically significant if p < .05.
Of the 128,117 scheduled appointments analyzed, 23,204 (18.1%) were missed. In the multivariable model, clinical nutrition had the greatest subspecialty odds of missed appointments, whereas cardiology had the lowest. Patient characteristics most strongly associated with missed appointments were public insurance, history of >2 missed appointments, appointment lead time, lesser medical complexity, Black race/ethnicity, and fewer medications.
Clinical characteristics including lesser medical complexity and fewer medications are associated with missed appointments in pediatric subspecialties.
失约会对患者、医疗服务提供方和医疗系统产生负面影响。本研究旨在：(1) 量化一家三级儿童医院 14 个儿科亚专科中错过预约的百分比；(2) 确定这些亚专科中与错过预约相关的患者特征。
我们从 2013 年 1 月 1 日至 2018 年 12 月 31 日期间的 14 个专科诊所的 267151 次门诊预约中提取了患者特征。使用儿科医疗复杂性算法对医疗复杂性进行分类。主要结局是预约失约。排除取消预约、影像/实验室检查、年龄大于 18 岁的患者和重复预约。使用卡方检验分析与失约相关的特征，并将 p<0.1 的特征纳入多变量模型。使用随机森林插补处理缺失数据，并假设数据“随机缺失”。如果 p<0.05，则认为变量具有统计学意义。
在分析的 128117 次预定预约中，有 23204 次（18.1%）失约。在多变量模型中，临床营养亚专科的预约失约几率最高，而心脏病学亚专科的预约失约几率最低。与错过预约最相关的患者特征是公共保险、有>2 次失约记录、预约提前时间、较低的医疗复杂性、黑种人/非洲裔美国人种族、以及较少的药物。
临床特征包括较低的医疗复杂性和较少的药物与儿科亚专科的预约失约有关。
