2019年冠状病毒病及社会经济决定因素对城市耳鼻喉科诊所预约未就诊情况的影响：来自一家安全网医院的回顾性分析

The Impact of COVID-19 and Socioeconomic Determinants on Appointment Non-Attendance in an Urban Otolaryngology Clinic: A Retrospective Analysis From a Safety Net Hospital.

作者信息

Puyo Elizabeth M, Salvati Lindsay R, Garg Neha, Bayly Henry, Kariveda Rohith R, Carnino Jonathan M, Nathan Ajay S, Levi Jessica R

机构信息

Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.

Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.

出版信息

Ann Otol Rhinol Laryngol. 2025 Feb;134(2):117-124. doi: 10.1177/00034894241295475. Epub 2024 Nov 5.

DOI:10.1177/00034894241295475

PMID:39501500

Abstract

OBJECTIVE

The objective of this study is to investigate various demographic, socioeconomic, COVID-related, and clinical factors associated with missed otolaryngology appointments in the outpatient setting at Boston Medical Center (BMC), an urban safety net hospital.

METHODS

A retrospective chart review was conducted on adults (≥18 years old) with scheduled appointments in the otolaryngology department at BMC from May 1, 2015, to May 1, 2022. Data were extracted from the electronic medical record and included appointment-related factors (eg, status and type), demographic variables (eg, age, sex, race, and ethnicity), and socioeconomic factors (eg, employment and insurance). Statistical analyses utilized a binary mixed-effects model to identify predictors of appointment non-attendance, with pre-COVID, during COVID, and post-COVID periods defined for comparative analysis.

RESULTS

Out of 14 050 patients, 5725 (40.8%) were classified as no-show. Older age decreased the likelihood of missing appointments (OR = 0.989, 95% CI = [0.986, 0.992]). Males (OR = 1.090, 95% CI = [1.022, 1.161]), Black/African American (OR = 2.047, 95% CI = [1.878, 2.231]), and Hispanic or Latino individuals (OR = 1.369, 95% CI = [1.232, 1.521]) were more likely to not show up. Retired participants (OR = 0.859, 95% CI = [0.753, 0.981]) and those with private insurance (OR = 0.698, 95% CI = [0.643, 0.758]) were less likely to miss appointments. During the COVID-19 pandemic, appointment attendance improved (OR = 0.865, 95% CI = [0.767, 0.976]). In-person appointments had a significantly higher non-attendance rate compared to telemedicine appointments (OR = 6.133, 95% CI = [5.248, 7.167]).

CONCLUSIONS

Appointment non-attendance in otolaryngology is influenced by various demographic and socioeconomic factors, with significant disparities observed among racial and ethnic groups. The COVID-19 pandemic altered attendance patterns, highlighting the potential benefits of telemedicine. These findings underscore the need for targeted interventions to address healthcare disparities and improve appointment adherence, particularly among minority and socioeconomically disadvantaged populations. Future research should incorporate patient perspectives to better understand barriers to appointment attendance.

摘要

目的

本研究旨在调查与波士顿医疗中心（BMC，一家城市安全网医院）门诊耳鼻喉科预约未就诊相关的各种人口统计学、社会经济、新冠相关及临床因素。

方法

对2015年5月1日至2022年5月1日在BMC耳鼻喉科预约就诊的成年人（≥18岁）进行回顾性病历审查。数据从电子病历中提取，包括预约相关因素（如状态和类型）、人口统计学变量（如年龄、性别、种族和民族）以及社会经济因素（如就业和保险）。统计分析采用二元混合效应模型来确定预约未就诊的预测因素，并定义了新冠疫情前、疫情期间和疫情后时期进行对比分析。

结果

在14050名患者中，5725名（40.8%）被归类为未就诊。年龄较大降低了错过预约的可能性（OR = 0.989，95% CI = [0.986, 0.992]）。男性（OR = 1.090，95% CI = [1.022, 1.161]）、黑人/非裔美国人（OR = 2.047，95% CI = [1.878, 2.231]）以及西班牙裔或拉丁裔个体（OR = 1.369，95% CI = [1.232, 1.521]）更有可能未就诊。退休参与者（OR = 0.859，95% CI = [0.753, 0.981]）和有私人保险的人（OR = 0.698，95% CI = [0.643, 0.758]）错过预约的可能性较小。在新冠疫情期间，预约就诊率有所提高（OR = 0.865，95% CI = [0.767, 0.976]）。与远程医疗预约相比，面对面预约的未就诊率显著更高（OR = 6.133，95% CI = [5.248, 7.167]）。

结论

耳鼻喉科预约未就诊受多种人口统计学和社会经济因素影响，不同种族和民族群体之间存在显著差异。新冠疫情改变了就诊模式，凸显了远程医疗的潜在益处。这些发现强调了需要有针对性的干预措施来解决医疗保健差异并提高预约依从性，特别是在少数族裔和社会经济弱势群体中。未来的研究应纳入患者的观点，以更好地理解预约就诊的障碍。