Understanding Non-Attendance in Pediatric Otolaryngology: A Retrospective Study of Demographics, Socioeconomics, and Pandemic Effects

Objective: The objective of this study is to identify factors associated with missed pediatric otolaryngology appointments at a large safety net hospital, focusing on demographic, socioeconomic, COVID-related, and appointment-related factors. Methods: A retrospective chart review was conducted on children (<18 years old) with scheduled outpatient appointments in the otolaryngology department from May 1, 2015, to May 1, 2022. Data were extracted from the EMR, encompassing appointment-related factors (eg, status and type) and patient demographics (age, sex, race, ethnicity, and zip code). Statistical analyses utilized a binary mixed-effects model to identify predictors of appointment non-attendance across pre-COVID, during COVID, and post-COVID periods. Results: Out of 13 868 patients, 3287 (19.2%) were classified as no-show. Older age increased the likelihood of missing appointments (OR = 1.015, 95% CI [1.003, 1.027]). Black/African American patients were more likely to not show up (OR = 1.676, 95% CI [1.376, 2.04]), and there was no significant difference in attendance by sex or ethnicity. Participants residing in regions outside of Boston and those with private insurance (OR = 0.549, 95% CI [0.460, 0.654]) were less likely to miss appointments. Patients with appointments after the COVID-19 pandemic were more likely to no-show compared to pre-pandemic (OR = 1.187, 95% CI [1.068, 1.319]). In-person appointments had a significantly higher no-show rate compared to telemedicine visits (OR = 63.953, 95% CI [26.696, 137.729]). Conclusions: Non-attendance in pediatric otolaryngology clinics is affected by various demographic and socioeconomic factors, revealing significant disparities among racial groups and age categories. The COVID-19 pandemic altered attendance patterns, indicating changes in healthcare dynamics and patient behavior and reinforcing the benefits of telemedicine. These findings underscore the need for future research to incorporate parental perspectives to understand barriers that caregivers face when bringing their children to clinic visits. Engaging families and exploring their specific challenges can inform targeted interventions aimed at improving appointment adherence in pediatric otolaryngology.