1103-P: Risk Factors for Visit Cancellations in a Tertiary Care Referral Clinic Specializing in Diabetic Eye Disease

Abstract

Patient cancellations of scheduled visits may result in missed opportunities for timely treatment and counseling and adversely impact quality of patient care. Identification of risk factors for cancellations might allow clinicians to define subgroups more likely to miss visits and interventions that prevent lapses in care. The purpose of this study was to identify patient factors associated with visit cancellations in patients followed at a tertiary care referral center for diabetes eye care. A retrospective review of the Joslin Diabetes Center’s Beetham Eye Institute electronic medical record was performed for patients with a first visit in 2016 and subsequent follow-up data. Analyses adjusted for repeated measures from the same patient. A total of 1,785 patients with diabetes (46.5% type 1, 53.5% type 2) were evaluated with baseline mean ± SD diabetes duration 24.5 ± 0.6 yrs, A1c 8.0 ± 0.1; 44.0% were female, 64.7% White, 10.3% Black and 4.0% Asian. Baseline diabetic retinopathy (DR) severity in the eye with more advanced disease was no DR in 40.3%, nonproliferative DR in 40.8% and proliferative DR (PDR) in 19.0%. Over the study time period, 333/13,085 (2.5%) visits were cancelled by patients. Bivariate analyses revealed increased cancellations were associated with older age (OR:1.00, p = 0.02), Asian versus White race (OR:3.77, p = 0.003), longer DM duration (OR:1.01, p < 0.05), the presence of DM complications (OR:1.43, p = 0.02), not being insured by Medicare (OR:1.29, p = 0.01), and the presence of PDR (OR:2.28, p = 0.004). After backwards elimination analysis, only PDR remained significantly associated with cancellations. These findings suggest that patient cancellations may be associated with DR severity. Future studies should explore this relationship in expanded patient datasets and the relationship of cancelled to missed visits in order to better understand potential barriers to follow up for patients undergoing diabetes eye care. Disclosure C. Gilbert: None. W. Fickweiler: None. A. Adam: None. J. Sun: Other Relationship; Self; Novo Nordisk, Roche Pharma, Research Support; Self; Adaptive Sensory Technology, Boehringer Ingelheim Pharmaceuticals, Inc., KalVista Pharmaceuticals, Optovue, Roche Pharma. Funding Massachusetts Lions Eye Research Fund