Abstract 11667: Factors Associated With No-Show and Cancellations at Adult Congenital Heart Disease Clinic

Abstract

Introduction: Many adults with congenital heart disease (ACHD) do not regularly access cardiology care; this has been associated with adverse outcomes. Clinic no-shows and cancellations limit access to care, and identify a population in need of intervention to improve engagement with care. We investigated factors associated with no-shows and cancellations in our academic ACHD clinic which draws from a large catchment area in Oregon, Washington, Idaho and California. Methods: The electronic medical record was queried to identify individuals ≥ 18 years of age with a scheduled appointment in the ACHD clinic from 2017-2020. Demographic and scheduling characteristics were recorded. Multivariate logistic regression was used to test for an association between variables and either no-show or patient-initiated cancellation. Results: Our sample included 7616 scheduled visits, and 4191 (55.0%) were completed. There were 332 (4.4%) no-shows and 1320 were canceled by the patient (17.3%). Factors associated with an increased risk of no-show to clinic were Medicaid (OR=1.86 (95% CI: 1.39, 2.49), p<0.001), prior no-show (OR per 1% increase in prior no-show rate 1.13 (95% CI: 1.13, 1.45), p<0.001), and an appointment at an off-site clinic (OR 2.16 (95% CI: 1.32, 3.45), p=0.002). Factors associated with an increased risk of a cancellation were in-person vs. virtual visits (OR 1.89 (95% CI 1.44, 2.53), p<0.001) and being an established patient (OR 1.38 (95% CI 1.17, 1.63), p<0.001). Patient age, day of the week, and appointment time were not associated with no-shows or cancellations. Discussion: Medicaid insurance, prior no-show, and off-site clinics are associated with a higher risk of no-show to ACHD clinic. As ACHD remains a limited resource, and lack of ACHD follow-up is associated with adverse events, limiting no-shows and canceled visits is an important goal. This study identifies a high-risk population which may benefit from targeted interventions to improve access to care.