Equity Gaps in Completed Referrals to Pediatric Cardiology Subspecialty Clinic

Background: Referral to subspecialists is a common and necessary occurrence in pediatrics. Socio-economic inequities may play a role in access to subspecialist care. We sought to describe the variables associated with incomplete cardiology clinic visits among referred pediatric patients, with a particular focus on equity gaps.

Methods: We conducted a retrospective chart review for patients less than 18 years of age who were referred to cardiology subspecialty clinics from 2017 to 2019 at a single institution. We collected patient demographic data, referral information, and cardiology clinic information to assess variables associated with incomplete referral visits and compared them to those that completed their appointments. We used classical univariable statistical methods and multivariable regression to identify predictors of incomplete clinic visits.

Results: There were 8767 new referrals and 6954 (79%) completed new cardiology clinic visits. Multivariable modelling showed that several patient factors were associated with a higher rate of incomplete visits following referral including Black or African American race (p < 0.001) and public insurance (p < 0.001). A longer time elapsed from initial referral to appointment made was also associated with a higher rate of incomplete visits (p < 0.001).

Conclusion: Race, time from referral to appointment made, and insurance type were factors associated with incomplete referral visits, illustrating important equity gaps in care. Interventions targeted to referrals with these identified risk factors may help improve completed referral rates.