Comprehensive Analysis to Uncover Determinants of Patient Appointment Compliance in Ophthalmology at the Kresge Eye Institute, USA

Figures & data

Figure 1 Study design with inclusion and exclusion criteria.

Table 1 Distribution of Demographic, Administrative, and Appointment Characteristics Among Compliant and Non-Compliant Appointments at KEI

	Non-Compliant	Compliant	p-value
	n= 124,504 (20.84%)	n= 472,860 (79.16%)
Demographic Characteristics
Female sex, No. (%)	73,650 (59.23%)	283,316 (59.92%)	<0.0001
Race (distribution of 5 categories with highest frequency)			<0.0001
African American/Black	91,335 (73.36%)	273,168 (57.77%)
Asian	1725 (1.39%)	9098 (1.92%)
Caucasian/White	12,612 (18.13%)	151,108 (31.96%)
Hispanic or Latino	2408 (1.93%)	8951 (1.90%)
Middle Eastern	3697 (2.97%)	14,489 (3.06%)
Age, Mean (IQR)	51.88 (40.91–65.20)	59.61 (50.54–72.86)	<0.00001
Ophthalmic specialty (distribution of 5 categories with highest frequency)			<0.0001
Comprehensive	24,781 (19.90%)	104,399 (22.08%)
Retina	16,208 (13.02%)	112,797 (23.84%)
Resident or Fellow	30,169 (24.23%)	79,533 (16.82%)
Glaucoma	18,040 (14.49%)	76,563 (16.19%)
Cornea	9596 (7.71%)	32,498 (6.87%)
Administrative Characteristics
Appointment Location (distribution of 3 categories with highest frequency)			<0.0001
KEI General	44,898 (36.06%)	167,810 (35.49%)
Residents	33,005 (26.51%)	84,524 (17.88%)
KEI Southfield	6594 (5.30%)	40,909 (8.65%)
Appointment Month (distribution of 3 categories with highest frequency)			<0.0001
March	11,105 (8.92%)	42,631 (9.02%)
June	10,997 (8.83%)	41,176 (8.71%)
April	10,457 (8.40%)	40,623 (8.59%)
Scheduling Provider			<0.0001
Primary Insurance Types (distribution of 3 categories with highest frequency)			<0.0001
Medicare Associated	38,185 (31.14%)	209,484 (44.41%)
Molina Associated	15,038 (12.26%)	33,033 (7.00%)
Blue Cross Blue Shield Associated	11,742 (9.57%)	67,811 (14.38%)
Appointment Characteristics
Appt rank number, Mean (IQR)	7.58 (2–9)	10.10 (2–13)	<0.00001

Table 2 Summary of Continuous Appointment Characteristics

		Mean	Range	Med (IQR)
Age (years)	CO	59.61	0.002–116	62.97 (50.54–72.86)
	NC	51.88	0.008–118	54.87 (40.91–65.20)
	All	58.01	0.002–118	61.36 (48.09–71.52)
Appt Rank	CO	10.10	1–175	6 (2–13)
	NC	7.58	1–143	4 (2–9)
	All	9.58	1–175	5 (2–12)
Percent Compliance (%)	CO	70.37%	4.17–100%	71.43% (25.00–83.33%)
	NC	37.80%	0–95.83%	40.00% (17.65–57.14%)
	All	63.58%	0–100%	66.67% (50.00–80.00%)
Total Number of Appointments per Patient’s Entire History	CO	19.53	1–175	14 (6–26)
	NC	12.73	1–175	7 (3–17)
	All	18.12	1–175	12 (5–24)

Figure 2 Frequency of appointments per ophthalmology subspecialty. The total n= 597,364 appointments were categorized across the indicated ophthalmic subspecialties seen at the KEI clinics.

Figure 3 Frequency of appointments per racial category. The total n= 597,364 appointments were categorized across the indicated racial categories seen at the KEI clinics.

Figure 4 Appointment frequency across each zip code. The total n= 829,034 appointments were mapped across each Michigan-based zip code using Microsoft Excel (see Methods section). The enlarged area represents metro Detroit.

Note: Four observations in our analysis were Michigan-based, but had an unspecified zip code listed in the EMR at that appointment.

Table 3 Comprehensive Multiple Logistic Regression Across Initial Appointments

Predictor*	Odds Ratio	P-value	95% CI
Patient Race
African American	Reference category
Race Unknown	0.10	<0.0001	0.09–0.12
Asian	1.89	<0.0001	1.54–2.33
Caucasian/White	2.82	<0.0001	2.59–3.07
Hispanic/Latino	1.58	<0.0001	1.44–1.73
Middle Eastern	1.65	<0.0001	1.48–1.84
More than 1 race	2.34	<0.0001	1.74–3.15
Native American Indian	1.55	0.066	0.97–2.46
Native Hawaiian or Pacific Islander	2.82	0.162	0.66–12.08
Other Race	0.68	<0.0001	0.60–0.77
Specialty
Comprehensive	Reference category
Cornea	0.93	0.050	0.87–1.00
Resident or Fellow	1.03	0.735	0.89–1.19
Glaucoma	0.93	0.037	0.87–1.00
Injection	5.94	0.088	0.77–46.03
Laser	Only 1 observation
Neuro	1.83	<0.0001	1.51–2.22
Optometry	0.47	<0.0001	0.35–0.65
Other	0.50	0.276	0.14–1.75
Plastics	0.83	0.141	0.66–1.06
Post-op	Only 1 observation
Strabismus	0.91	0.059	0.83–1.00
Retina	1.04	0.49	0.94–1.15
Appointment Location
KEI General Detroit clinic location as reference category
Bingham Farms	2.03	<0.0001	1.80–2.29
Clinton Township	7.41	<0.0001	3.48–15.81
Dearborn	2.71	<0.0001	2.13–3.46
Hutzel Warren	3.00	<0.0001	2.41–3.74
KEI Dearborn Oakwood	0.92	0.064	0.84–1.00
KEI Dearborn Optometry	1.72	<0.0001	1.24–2.38
KEI Adult Muscle	0.80	0.022	0.66–0.97
KEI Sinai Grace	1.88	<0.0001	1.33–2.67
KEI Sinai Grace Ophthalmology	0.77	<0.0001	0.69–0.87
KEI Well Eye Care	1.13	0.434	0.83–1.55
Lake Orion	5.78	<0.0001	4.52–7.40
Novi	7.43	<0.0001	3.57–15.49
OR Boarding	163.32	<0.0001	23.33–1143.21
Port Huron	1.86	<0.0001	1.44–2.40
Residents	1.15	0.095	0.98–1.34
Southfield	1.98	<0.0001	1.80–2.18
Taylor	1.56	<0.0001	1.29–1.89
Troy	2.27	<0.0001	1.84–2.81
KEI Well Eye Clinic	2.01	<0.0001	1.41–2.86
Ypsilanti	6.51	<0.0001	4.04–10.48
Appointment Month
January month as reference category
February	1.14	<0.0001	1.07–1.21
March	1.31		1.21–1.42
April	1.37		1.29–1.48
May	1.35		1.27–1.44
June	1.26		1.18–1.35
July	1.31		1.21–1.43
August	1.40		1.30–1.51
September	1.26		1.16–1.36
October	1.32		1.23–1.42
November	1.30		1.20–1.41
December	1.29		1.19–1.39
Model Characteristics
Number of Observations	106,152
Prob> chi	<0.00001
Pseudo R2	0.1610
Area under ROC curve	0.75

Notes: *Appointment compliance is the outcome (dependent) variable and race, age, sex, specialty, appointment location, month, and appointment rank are the predictors. Also, please note that 75 insurance categories have been omitted for table length but can be found in the supplementary materials.

Figure 5 Receiver operating characteristic curve and associated AUC for logistic regressions across all appointments. Also refer Table 3 for detailed results.