Predictors of No-Show in a Safety-Net Otolaryngology Clinic: A Repeated Measures Approach.

Abstract

Objective: Identify predictors of patient no-show at an urban safety-net otolaryngology outpatient clinic.

Methods: Retrospective cohort study including all scheduled patients and appointments in 2023. Predictor variables included sociodemographic factors, primary diagnosis, insurance, and the neighborhood deprivation index (NDI) based on census tract information. The outcome was analyzed as a binary variable using univariate and multivariate mixed-effects logistic regression models.

Results: Among 2339 patients and 4641 scheduled appointments, 1639 patients completed all scheduled visits and 700 (29.9%) missed at least 1 visit. Among all appointments, 18.4% were missed. The prior no-show rate was 9% (IQR 4%-18%), and days from scheduling to appointment was 42 days (IQR 19-75). Univariate analysis demonstrated significant sociodemographic factors associated with higher odds of missing an appointment, including NDI (OR 1.03, p = 0.001), male gender (OR 1.35, p = 0.004), Black/African American race (OR 1.49, p = 0.022), unemployment and disability status (OR 1.45, p = 0.007 and OR 2.12, p < 0.001 respectively), unstable/unknown housing (OR 3.66, p < 0.001), and sexual orientation as lesbian or gay (OR 1.93, p = 0.003). NDI remained a significant factor in multivariate analysis (OR 1.03, p = 0.001). Patient portal inactivation and lead time were significant intervenable factors in multivariate analysis (OR 1.23, p = 0.049 and OR 1.26, p < 0.001, respectively).

Conclusion: NDI, patient portal activation, and time from appointment scheduling to visit are significant predictors of patient no-show. This study offers insights into potential interventions addressing specific barriers to improving patient no-show rates for an urban, safety-net outpatient population.

Level of evidence: 3 (retrospective cohort study).