A0619 - Impact of the COVID-19 Pandemic and Social Determinants of Health on Missed Visits

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

HS

Harsha Sanaka

Cleveland Clinic
Cleveland, OH

Harsha Sanaka, ¹, Rajat Garg, MD², Vidhi Patel, MD¹, John McMichael, PhD², Carole Macaron, MD²
¹Cleveland Clinic, Cleveland, OH; ²Cleveland Clinic Foundation, Cleveland, OH

Introduction: The emergence of the COVID-19 pandemic led to dramatic changes in clinical practice, such as increased usage of telehealth services. Though these changes may have facilitated healthcare access for some, they can be detrimental to patients unfamiliar with utilizing technology, which may be reflected in missed visit rates. Therefore, we aimed to identify the trends and factors associated with missed visits.

Methods: The study population consisted of patients receiving outpatient care in the Cleveland Clinic Gastroenterology department during the lock-down period from March 9^th, 2020 to June 18^th, 2020 and representative samples from corresponding periods in 2019 (before COVID-19) and in 2021 (after the flattening of the COVID-19 surge). “Missed” visits were defined as those in which patients either cancelled or did not show up to scheduled visits. The following variables were collected and compared between the two groups (missed and completed visits): demographic data, substance abuse, insurance data, employment status, and median household income obtained from zip codes. Univariate and multivariable logistic regression analyses were performed to determine factors associated with missed visits.

Results: There was increase in missed visit rates since the onset of the pandemic (751 (4.2%), 1340 (10%,) and 1693 (10.4%) missed visits in 2019, 2020, and 2021, respectively (p < 0.001)). During the study periods, there were a total of 3768 missed visits and 43262 completed visits. Missed visits were more frequent among the following groups: age < 65 years, non-white race, Medicaid or other public insurance, the lowest two quartiles of median income, unemployed and unknown employment status, single marital status, tobacco and illicit drug use, and non-English speakers (Table 1). On multivariate analysis, missed visits were 1% less likely for every one-year increase in age; more prevalent with non-white race, Medicaid and other public insurance, unemployment, single status, tobacco and illicit drug use, and non-English/Spanish speakers; and less prevalent for those in the two highest quartiles of median income (Table 1).

Discussion: The ever-increasing missed visit rate since the onset of the pandemic is concerning. The increased association of missed visits with certain demographic groups is also notable. Future efforts must target these underserved groups as healthcare systems adapt to the pandemic.

Factor	Missed (N = 3768)	Completed (N = 43262)	p-value	Adjusted Odds Ratio for Missed Visits (95% CI)	p-value
Age in Years (Mean ± SD)	52.9 ± 17.8	56.6 ± 17.5	< 0.001	0.99 (0.98 - 0.99) for every one-year increase in age	< 0.001
Age ≥ 65 Years	1098 (29.1%)	16260 (37.6%)	< 0.001
Sex			0.46
Male	1456 (38.6%)	16459 (38%)
Female	2312 (61.4%)	26804 (62%)
Race			< 0.001
White	2471 (65.7%)	33423 (77.3%)		Reference
Black	808 (21.5%)	5993 (13.9%)		1.42 (1.29 - 1.57)	< 0.001
Hispanic	216 (5.7%)	1577 (3.6%)		1.34 (1.13 - 1.57)	< 0.001
Others	268 (7.1%)	2220 (5.1%)		1.44 (1.25 - 1.66)	< 0.001
Type of Insurance			< 0.001
Private	1955 (53.3%)	26461 (62.4%)		Reference
Medicare	693 (18.9%)	8981 (21.2%)		1.05 (0.95 - 1.16)	0.29
Medicaid and other public	984 (26.8%)	6433 (15.2%)		1.35 (1.23 - 1.48)	< 0.001
No insurance	35 (1%)	504 (1.2%)		1.04 (0.73 - 1.47)	0.81
Median Household Income by Zip Code (by quartile)			< 0.001
Lowest	1304 (34.6%)	10321 (23.9%)		Reference
Second	1093 (29%)	10698 (24.7%)		1.02 (0.92 - 1.12)	0.64
Third	664 (17.6%)	11182 (25.8%)		0.64 (0.58 - 0.72)	< 0.001
Highest	707 (18.8%)	11059 (25.6%)		0.71 (0.63 - 0.71)	< 0.001
Employment Status			< 0.001
Employed	1234 (23.8%)	16868 (39%)		Reference
Unemployed	1959 (52%)	16783 (38.8%)		1.45 (1.33 - 1.58)	< 0.001
Retired	488 (13%)	8709 (20.2%)		0.99 (0.88 - 1.13)	0.99
Unknown	84 (2.2%)	852 (2%)		0.98 (0.73 - 1.30)	0.88
Marital Status			< 0.001
Married	1565 (41.5%)	21463 (49.6%)		Reference
Single	2153 (57.1%)	21206 (49%)		1.09 (1.10 - 1.17)	0.023
Others	50 (1.3%)	593 (1.4%)		0.94 (0.68 - 1.29)	0.71
H/o Tobacco Use	756 (20.4%)	5903 (13.8%)	< 0.001	1.23 (1.12 - 1.35)	< 0.001
H/o Alcohol Use	1555 (43.2%)	18694 (45%)	0.074
H/o Illicit Drug Use	352 (9.7%)	2657 (6.4%)	< 0.001	1.14 (1.01 - 1.29)	0.03
Primary Language			< 0.001
English	3639 (96.6%)	42355 (97.9%)		Reference
Spanish	64 (1.7%)	413 (1%)		1.20 (0.89 - 1.63)	0.21
Other	64 (1.7%)	495 (1.1%)		1.37 (1.03 - 1.82)	0.028

Table: Table 1: Patient Characteristics Associated with Missed Visits

Disclosures:

Harsha Sanaka indicated no relevant financial relationships.

Rajat Garg indicated no relevant financial relationships.

Vidhi Patel indicated no relevant financial relationships.

John McMichael indicated no relevant financial relationships.

Carole Macaron: Entire biosciences – Grant/Research Support. Freenome – Grant/Research Support.

Harsha Sanaka, ¹, Rajat Garg, MD², Vidhi Patel, MD¹, John McMichael, PhD², Carole Macaron, MD². A0619 - Impact of the COVID-19 Pandemic and Social Determinants of Health on Missed Visits, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.