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Flores EJ, Daye D, Peña MA, Lopez DB, Jaimes C, Glover M. Analysis of socioeconomic and demographic factors and imaging exam characteristics associated with missed appointments in pediatric radiology. Pediatr Radiol 2021; 51:2083-2092. [PMID: 34115180 PMCID: PMC8194384 DOI: 10.1007/s00247-021-05111-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/12/2021] [Accepted: 05/17/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Missed appointments can have an adverse impact on health outcomes by delaying appropriate imaging, which can be critical in influencing treatment decisions. OBJECTIVE To assess for socioeconomic and imaging exam factors associated with missed appointments among children scheduled for diagnostic imaging. MATERIALS AND METHODS We retrospectively analyzed children (<18 years) scheduled for outpatient diagnostic imaging during a 12-month period. In doing so, we obtained socioeconomic and radiology exam characteristics (modality, intravenous contrast administration, radiation and use of sedation) data from the electronic medical record. We employed multivariate logistic regression to assess the association of socioeconomic, demographic and imaging exam characteristics with imaging missed appointments. RESULTS In total, 7,275 children met inclusion criteria. The mean age was 8.8 years (standard deviation [SD] = 6.2 years) and the study population consisted of 52% female gender, 69% White race, 38% adolescent age group and 32% with a median household income by ZIP-code category of <$50,000. Logistic regression showed increased likelihood of missed appointments among children of Black/African-American race (odds ratio [OR] = 1.9; 95% confidence interval [CI] = 1.4-2.5); with insurance categories including Medicaid (OR=2.0; 95% CI=1.6-2.4), self-pay (OR=2.1; 95% CI=1.3-3.6) and other (OR=2.7; 95% CI=1.3-5.4); with <$50,000 median household income by ZIP-code category (OR=1.7; 95% CI=1.4-2.0); and with examination wait time of 7-21 days (OR=2.7; 95% CI=2.1-3.5) and >21 days (OR=3.7; 95% CI=2.9-4.8). The use of radiation, intravenous contrast agent or sedation was not associated with increased likelihood of missed appointments. CONCLUSION Expanding our knowledge of how different socioeconomic and imaging-related factors influence missed appointments among children can serve as a foundational step to better understand existing and emerging disparities and inform strategies to advance health equity efforts in radiology.
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Affiliation(s)
- Efrén J. Flores
- grid.32224.350000 0004 0386 9924Department of Radiology, Massachusetts General Hospital, 55 Fruit St., BLK SB-0029A, Boston, MA 02114 USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Dania Daye
- grid.32224.350000 0004 0386 9924Department of Radiology, Massachusetts General Hospital, 55 Fruit St., BLK SB-0029A, Boston, MA 02114 USA
| | - Miguel A. Peña
- grid.32224.350000 0004 0386 9924Department of Radiology, Massachusetts General Hospital, 55 Fruit St., BLK SB-0029A, Boston, MA 02114 USA ,Harvard Kennedy School of Government, Cambridge, MA USA
| | - Diego B. Lopez
- grid.32224.350000 0004 0386 9924Department of Radiology, Massachusetts General Hospital, 55 Fruit St., BLK SB-0029A, Boston, MA 02114 USA
| | - Camilo Jaimes
- grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA ,grid.2515.30000 0004 0378 8438Department of Radiology, Boston Children’s Hospital, Boston, MA USA
| | - McKinley Glover
- grid.32224.350000 0004 0386 9924Department of Radiology, Massachusetts General Hospital, 55 Fruit St., BLK SB-0029A, Boston, MA 02114 USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
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Pahade JK, Trout AT, Zhang B, Bhambhvani P, Muse VV, Delaney LR, Zucker EJ, Pandharipande PV, Brink JA, Goske MJ. What Patients Want to Know about Imaging Examinations: A Multiinstitutional U.S. Survey in Adult and Pediatric Teaching Hospitals on Patient Preferences for Receiving Information before Radiologic Examinations. Radiology 2018; 287:554-562. [PMID: 29436946 DOI: 10.1148/radiol.2017170592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To identify what information patients and parents or caregivers found useful before an imaging examination, from whom they preferred to receive information, and how those preferences related to patient-specific variables including demographics and prior radiologic examinations. Materials and Methods A 24-item survey was distributed at three pediatric and three adult hospitals between January and May 2015. The χ2 or Fisher exact test (categorical variables) and one-way analysis of variance or two-sample t test (continuous variables) were used for comparisons. Multivariate logistic regression was used to determine associations between responses and demographics. Results Of 1742 surveys, 1542 (89%) were returned (381 partial, 1161 completed). Mean respondent age was 46.2 years ± 16.8 (standard deviation), with respondents more frequently female (1025 of 1506, 68%) and Caucasian (1132 of 1504, 75%). Overall, 78% (1117 of 1438) reported receiving information about their examination most commonly from the ordering provider (824 of 1292, 64%), who was also the most preferred source (1005 of 1388, 72%). Scheduled magnetic resonance (MR) imaging or nuclear medicine examinations (P < .001 vs other examination types) and increasing education (P = .008) were associated with higher rates of receiving information. Half of respondents (757 of 1452, 52%) sought information themselves. The highest importance scores for pre-examination information (Likert scale ≥4) was most frequently assigned to information on examination preparation and least frequently assigned to whether an alternative radiation-free examination could be used (74% vs 54%; P < .001). Conclusion Delivery of pre-examination information for radiologic examinations is suboptimal, with half of all patients and caregivers seeking information on their own. Ordering providers are the predominant and preferred source of examination-related information, with respondents placing highest importance on information related to examination preparation. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Jay K Pahade
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, New Haven, Conn 06520 (J.K.P.); Department of Radiology (A.T.T., M.J.G.) and Department of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Radiology, Division of Molecular Imaging and Therapeutics, University of Alabama at Birmingham, Birmingham, Ala (P.B.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (V.V.M., J.A.B.); Department of Radiology, Indiana University, Riley Hospital for Children, Indianapolis, Ind (L.R.D.); Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, Calif (E.J.Z.); Department of Radiology, Massachusetts General Hospital, MGH Institute for Technology Assessment, Boston, Mass (P.V.P.)
| | - Andrew T Trout
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, New Haven, Conn 06520 (J.K.P.); Department of Radiology (A.T.T., M.J.G.) and Department of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Radiology, Division of Molecular Imaging and Therapeutics, University of Alabama at Birmingham, Birmingham, Ala (P.B.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (V.V.M., J.A.B.); Department of Radiology, Indiana University, Riley Hospital for Children, Indianapolis, Ind (L.R.D.); Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, Calif (E.J.Z.); Department of Radiology, Massachusetts General Hospital, MGH Institute for Technology Assessment, Boston, Mass (P.V.P.)
| | - Bin Zhang
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, New Haven, Conn 06520 (J.K.P.); Department of Radiology (A.T.T., M.J.G.) and Department of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Radiology, Division of Molecular Imaging and Therapeutics, University of Alabama at Birmingham, Birmingham, Ala (P.B.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (V.V.M., J.A.B.); Department of Radiology, Indiana University, Riley Hospital for Children, Indianapolis, Ind (L.R.D.); Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, Calif (E.J.Z.); Department of Radiology, Massachusetts General Hospital, MGH Institute for Technology Assessment, Boston, Mass (P.V.P.)
| | - Pradeep Bhambhvani
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, New Haven, Conn 06520 (J.K.P.); Department of Radiology (A.T.T., M.J.G.) and Department of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Radiology, Division of Molecular Imaging and Therapeutics, University of Alabama at Birmingham, Birmingham, Ala (P.B.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (V.V.M., J.A.B.); Department of Radiology, Indiana University, Riley Hospital for Children, Indianapolis, Ind (L.R.D.); Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, Calif (E.J.Z.); Department of Radiology, Massachusetts General Hospital, MGH Institute for Technology Assessment, Boston, Mass (P.V.P.)
| | - Victorine V Muse
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, New Haven, Conn 06520 (J.K.P.); Department of Radiology (A.T.T., M.J.G.) and Department of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Radiology, Division of Molecular Imaging and Therapeutics, University of Alabama at Birmingham, Birmingham, Ala (P.B.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (V.V.M., J.A.B.); Department of Radiology, Indiana University, Riley Hospital for Children, Indianapolis, Ind (L.R.D.); Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, Calif (E.J.Z.); Department of Radiology, Massachusetts General Hospital, MGH Institute for Technology Assessment, Boston, Mass (P.V.P.)
| | - Lisa R Delaney
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, New Haven, Conn 06520 (J.K.P.); Department of Radiology (A.T.T., M.J.G.) and Department of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Radiology, Division of Molecular Imaging and Therapeutics, University of Alabama at Birmingham, Birmingham, Ala (P.B.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (V.V.M., J.A.B.); Department of Radiology, Indiana University, Riley Hospital for Children, Indianapolis, Ind (L.R.D.); Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, Calif (E.J.Z.); Department of Radiology, Massachusetts General Hospital, MGH Institute for Technology Assessment, Boston, Mass (P.V.P.)
| | - Evan J Zucker
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, New Haven, Conn 06520 (J.K.P.); Department of Radiology (A.T.T., M.J.G.) and Department of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Radiology, Division of Molecular Imaging and Therapeutics, University of Alabama at Birmingham, Birmingham, Ala (P.B.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (V.V.M., J.A.B.); Department of Radiology, Indiana University, Riley Hospital for Children, Indianapolis, Ind (L.R.D.); Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, Calif (E.J.Z.); Department of Radiology, Massachusetts General Hospital, MGH Institute for Technology Assessment, Boston, Mass (P.V.P.)
| | - Pari V Pandharipande
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, New Haven, Conn 06520 (J.K.P.); Department of Radiology (A.T.T., M.J.G.) and Department of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Radiology, Division of Molecular Imaging and Therapeutics, University of Alabama at Birmingham, Birmingham, Ala (P.B.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (V.V.M., J.A.B.); Department of Radiology, Indiana University, Riley Hospital for Children, Indianapolis, Ind (L.R.D.); Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, Calif (E.J.Z.); Department of Radiology, Massachusetts General Hospital, MGH Institute for Technology Assessment, Boston, Mass (P.V.P.)
| | - James A Brink
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, New Haven, Conn 06520 (J.K.P.); Department of Radiology (A.T.T., M.J.G.) and Department of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Radiology, Division of Molecular Imaging and Therapeutics, University of Alabama at Birmingham, Birmingham, Ala (P.B.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (V.V.M., J.A.B.); Department of Radiology, Indiana University, Riley Hospital for Children, Indianapolis, Ind (L.R.D.); Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, Calif (E.J.Z.); Department of Radiology, Massachusetts General Hospital, MGH Institute for Technology Assessment, Boston, Mass (P.V.P.)
| | - Marilyn J Goske
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, New Haven, Conn 06520 (J.K.P.); Department of Radiology (A.T.T., M.J.G.) and Department of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Radiology, Division of Molecular Imaging and Therapeutics, University of Alabama at Birmingham, Birmingham, Ala (P.B.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (V.V.M., J.A.B.); Department of Radiology, Indiana University, Riley Hospital for Children, Indianapolis, Ind (L.R.D.); Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, Calif (E.J.Z.); Department of Radiology, Massachusetts General Hospital, MGH Institute for Technology Assessment, Boston, Mass (P.V.P.)
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