Neighborhood Effects on Missed Appointments in a Large Urban Academic Multispecialty Practice

Abstract

Background: Missed appointments diminish the continuity and quality of care.

Objective: To determine whether missing scheduled appointments is associated with characteristics of the populations in places where patients reside.

Design: Retrospective cross-sectional study using data extracted from electronic health records linked to population descriptors for each patient's census tract of residence.

Patients: A total of 58,981 patients ≥18 years of age with 275,682 scheduled appointments during 2014-2015 at a multispecialty outpatient practice.

Main measures: We used multinomial generalized linear mixed models to examine associations between the outcomes of scheduled appointments (arrived, canceled, or missed) and selected characteristics of the populations in patients' census tracts of residence (racial/ethnic segregation based on population composition, levels of poverty, violent crime, and perceived safety and social capital), controlling for patients' age, gender, type of insurance, and type of clinic service.

Key results: Overall, 17.5% of appointments were missed. For appointments among patients residing in census tracts in the highest versus lowest quartile for each population metric, adjusted odds ratios (aORs) for missed appointments were 1.27 (CI 1.19, 1.35) for the rate of violent crime, 1.27 (CI 1.20, 1.34) for the proportion Hispanic, 1.19 (CI 1.12, 1.27) for the proportion living in poverty, 1.13 (CI 1.05, 1.20) for the proportion of the census tract population that was Black, and 1.06 (CI 1.01, 1.11 for perceived neighborhood safety.

Conclusions: Characteristics of the places where patients reside are associated with missing scheduled appointments, including high levels of racial/ethnic segregation, poverty, and violent crime and low levels of perceived neighborhood safety. As such, targeting efforts to improve access for patients living in such neighborhoods will be particularly important to address underlying social determinants of access to health care.

Keywords: missed appointment; neighborhood characteristics; social determinants.