(124) Social and Clinical Predictors of Missed Otolaryngology Visits in an Otolaryngology Outpatient Setting

Introduction: Otolaryngology outpatient non-attendance disproportionately affects publicly insured and socially vulnerable patients and represents a critical barrier to equitable access to specialty care. This study examined demographic, appointment-level, and social determinants of health (SDOH) factors associated with missed otolaryngology appointments in a diverse urban patient population.

Methods: A retrospective cohort analysis was conducted using electronic health record (EHR) data from 2023–2024 at an otolaryngology outpatient clinic. Social and clinical factors were compared between patients who attended versus missed their appointments, with group differences assessed using chi-square and ANOVA tests. System-level interventions such as text reminders, scheduling method, and EHR registration were collected for planned analysis. Univariate and multivariate logistic regression models were used to evaluate predictors of non-attendance, adjusting for demographic variables and covariates that altered odds ratios by ≥10%.

Results: Among 3,434 patient records, 1,055 (30.7%) missed and 2,379 (69.3%) attended their appointments. Non-attendance was more frequent among older, female, Black, disabled or retired, and publicly insured patients, as well as those with a listed caregiver and greater comorbidity burden. Return visits were missed more often than new visits. Several self-reported SDOH factors—including financial strain, stress concerns, depression risk, food insecurity, housing instability, and transportation needs—along with smoking status, were significant in univariate analyses. Stress concerns remained associated with non-attendance in multivariate analysis.

Conclusions: Demographic, appointment-level, and social determinants of health (SDOH) factors were associated with missed otolaryngology appointments, underscoring the need for targeted interventions addressing social and clinical barriers to improve appointment attendance in otolaryngology outpatient settings.