Transition to telemedicine and its impact on missed appointments in community-based clinics

Figures & data

Table 1. Unique patient baseline characteristics (n = 85,431).

Variable	Total, n (%)
Age
<18	39,821 (46.6)
18–64	41,511 (48.6)
>64	4081 (4.8)
	Mean (SD)
Age at appointment	27.1 (20.5)
Gender
Female	51,906 (60.8))
Male	33,507 (39.2)
Ethnicity
Hispanic	44,101 (51.6)
Non-Hispanic	41,312 (48.4)
Race
White	52,571 (61.6)
Black or African American	10,168 (11.9)
Asian	2540 (3.0)
American Indian, Alaska Native, other Pacific Is.	978 (1.2)
Mixed race	1744 (2.0)
Other	17,412 (20.4)
Metropolitan status of patient residence
Nonmetropolitan	3340 (3.9)
Metropolitan	82,073 (96.1)
MUA status of patient residence
Non-MUA	43,170 (50.3)
MUA	42,694 (49.7)
Visit history (December 2018 to February 2020)
1–2 visits	34,224 (40.1)
3–4 visits	16,267 (19.0)
5+ visits	34,922 (40.9)

Table 2. Bivariate associations of baseline characteristics by missed appointment status (n = 278,171).

Variable	Total, n (%)	Missed appointment status		p-Value
		Made appointment (n = 228,308), n (%)	Missed appointment (n = 49,863), n (%)
Age				<.001
<18	112,711 (40.5)	93,572 (83.0)	19,139 (17.0)
18–64	153,110 (55.0)	124,105 (81.1)	29,005 (18.9)
>64	12,350 (4.4)	10,631 (86.1)	1719 (13.9)
Ethnicity				<.001
Non-Hispanic	139,134 (50.0)	115,154 (82.8)	23,980 (17.2)
Hispanic	139,037 (50.0)	113,154 (81.4)	25,883 (18.6)
Race				<.001
White	174568 (62.8)	144,795 (82.9)	29,773 (17.1)
Black or African American	34,538 (12.4)	26,901 (77.9)	7637 (22.1)
Asian	7104 (2.6)	6201 (87.3)	903 (12.7)
American Indian, Alaska Native, other Pacific Is.	3202 (1.2)	2589 (80.9)	613 (19.1)
Mixed race	6136 (2.2)	5034 (82.0)	1102 (18.0)
Other	52,623 (18.9)	42,788 (81.3)	9835 (18.7)
Insurance coverage				<.001
Private insurance	47,390 (17.0)	41,795 (88.2)	5595 (11.8)
Medicare	16,234 (5.8)	13,638 (84.0)	2596 (16.0)
Medicaid	123,868 (44.5)	102,108 (82.4)	21,760 (17.6)
Uninsured	88,601 (31.9)	70,736 (79.8)	17,865 (20.2)
Service line				<.001
Family practice	88,044 (31.7)	70,234 (79.8)	17,810 (20.2)
Mental health	59,074 (21.2)	49,328 (83.5)	9746 (16.5)
Obstetrics/gynecology	40,035 (14.4)	33,257 (83.1)	6778 (16.9)
Paediatrics	84,671 (30.4)	69,981 (82.7)	14,690 (17.3)
Senior care	6329 (2.3)	5503 (86.9)	826 (13.1)
Metropolitan status				.01
Nonmetropolitan	9418 (3.4)	7829 (83.1)	1589 (16.9)
Metropolitan	268,610 (96.6)	220,355 (82.0)	48,255 (18.0)
Distance from clinic				.05
<5 miles	76,606 (27.5)	62,785 (82.0)	13,821 (18.0)
5–10 miles	72,930 (26.2)	59,952 (82.2)	12,978 (17.8)
10–20 miles	77,670 (27.9)	63,845 (82.2)	13,825 (17.8)
20–50 miles	44,565 (16.0)	36,417 (81.7)	8148 (18.3)
≥50 miles	6400 (2.3)	5309 (83.0)	1091 (17.0)
MUA status				<.001
Non-MUA	142,496 (51.2)	115,854 (81.3)	26,642 (18.7)
MUA	135,532 (48.7)	112,330 (82.9)	23,202 (17.1)
Appointment type				<.001
Face-to-face appointments	207,621 (74.6)	168,871 (81.3)	38,750 (18.7)
Telemedicine appointments	70,550 (25.4)	59,437 (84.2)	11,113 (15.8)

Note. Missing data not included in statistical analyses.

Table 3. Telemedicine use and missed appointments over time (1 March to 30 November 2020).

Month	Total appointments, n	Telemedicine appointments [n (%) of total appointments]	Missed appointments [n (%) of total appointments]
March 2020	34,164	1316 (3.9)	6606 (19.3)
April 2020	24,347	8496 (34.9)	4321 (17.7)
May 2020	25,407	8556 (33.7)	4437 (17.5)
June 2020	31,985	9445 (29.5)	5869 (18.3)
July 2020	33,255	10,144 (30.5)	6023 (18.1)
August 2020	31,948	8463 (26.5)	5687 (17.8)
September 2020	32,790	8697 (26.5)	5973 (18.2)
October 2020	33,788	7987 (23.6)	5854 (17.3)
November 2020	30,487	7446 (24.4)	5093 (16.7)

Table 4. Mixed-effect logistic regression model of the relationship between telemedicine and missed appointments.

Variable	OR	MV-adjusted OR^a, 95% CI	p-Value
Appointment type
Face-to-face appointment	Ref.
Telemedicine appointment	0.87	0.84–0.89	<.001
Age
18–64	Ref.
<18	0.83	0.79–0.88	<.001
>64	0.71	0.65–0.77	<.001
Gender
Male	Ref.
Female	1.01	0.98–1.03	.64
Ethnicity
Non-Hispanic	Ref.
Hispanic	1.19	1.16–1.23	<.001
Race
White	Ref.
Black or African American	1.61	1.54–1.68	<.001
Asian	0.82	0.74–0.90	<.001
American Indian, Alaska Native, other Pacific Is.	1.19	1.05–1.35	.013
Mixed race	1.22	1.13–1.36	<.001
Insurance coverage
Private insurance	Ref.
Medicare	1.62	1.50–1.75	<.001
Medicaid	1.75	1.68–1.83	<.001
Uninsured	1.90	1.82–1.92	<.001
Service line
Family practice	Ref
Mental health	1.20	1.15–1.25	<.001
Obstetrics/gynecology	0.88	0.84–0.92	<.001
Paediatrics	0.94	0.89–1.00	.05
Senior care	0.74	0.67–0.81	<.001
Metropolitan status
Nonmetropolitan	Ref.
Metropolitan	1.06	0.98–1.14	.15
Distance from clinic
<5 miles	Ref.
5–10 miles	1.02	0.93–1.13	.59
10–20 miles	1.01	0.89–1.08	.71
20–50 miles	1.02	0.89–1.09	.80
≥50 miles	1.00	0.91–1.11	.93
MUA status
Non-MUA	Ref.
MUA	0.95	0.93–0.98	.001
Visit history (December 2018 to February 2020)
1–2 visits	Ref.
3–4 visits	1.67	1.61–1.74	<.001
5+ visits	1.61	1.56–1.66	<.001
Intraclass correlation coefficient for random effect
	ICC	95% CI	Std. Err.
Patient	0.20	0.19–0.21	0.003

^a MV-adjusted OR, multivariate adjusted odds ratio.

Table 5. Mixed-effect logistic regression model of missed appointments, stratified by appointment type.

Variable	In-person	Telemedicine
Age
18–64	Ref.	Ref.
<18	0.86*	0.68*
>64	0.65*	0.84*
Gender
Male	Ref.	Ref.
Female	0.97	1.15*
Ethnicity
Non-Hispanic	Ref.	Ref.
Hispanic	1.13*	1.46*
Race
White	Ref.	Ref.
Black or African American	1.63*	1.53*
Asian	0.80*	0.86
American Indian, Alaska Native, other Pacific Is.	1.16*	1.28
Mixed race	1.31*	0.99
Insurance coverage
Private insurance	Ref.	Ref.
Medicare	1.63*	1.75*
Medicaid	1.80*	1.69*
Uninsured	1.95*	1.75*
Service line
Family practice	Ref.	Ref.
Mental health	1.57*	0.78*
Obstetrics/gynecology	0.90*	0.92
Paediatrics	0.95	0.97
Senior care	0.83*	0.53*
Metropolitan status
Nonmetropolitan	Ref.	Ref.
Metropolitan	1.15*	0.82*
Distance from clinic
<5 miles	Ref.	Ref.
5–10 miles	0.97	1.15
10–20 miles	0.94	1.07
20–50 miles	0.95	1.11
≥50 miles	0.95	1.22*
MUA status
Non-MUA	Ref.	Ref.
MUA	0.95*	0.94
Visit History (December 2018 to February 2020)
1–2 visits	Ref.	Ref.
3–4 visits	1.88*	0.91*
5+ visits	1.82*	0.92*
Intraclass correlation coefficient for random effect
	ICC (Std. Err.)	ICC (Std. Err.)
Patient	0.22 (0.004)	0.26 (0.009)

*p < .05.

Data availability statement

Given the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data are not available.