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Inequitable access: factors associated with incomplete referrals to paediatric cardiology

Published online by Cambridge University Press:  18 July 2022

Paul W. Warren Open the ORCID record for Paul W. Warren [Opens in a new window] ,
Andrew F. Beck ,
Huaiyu Zang ,
Jeffrey Anderson  and
Christopher Statile
Paul W. Warren*
Affiliation:
Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 2003, Cincinnati, OH 45229, USA
Andrew F. Beck
Affiliation:
General and Community Pediatrics and Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
Huaiyu Zang
Affiliation:
Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
Jeffrey Anderson
Affiliation:
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
Christopher Statile
Affiliation:
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
*
Author for correspondence: Paul W. Warren, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 5018, Cincinnati, OH 45229, USA. Tel: 513-207-9297. E-mail: paul.warren@cchmc.org
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Abstract

Objective:

To assess the variables associated with incomplete and unscheduled cardiology clinic visits among referred children with a focus on equity gaps.

Study design:

We conducted a retrospective chart review for patients less than 18 years of age who were referred to cardiology clinics at a single quaternary referral centre from 2017 to 2019. We collected patient demographic data including race, an index of neighbourhood socio-economic deprivation linked to a patient’s geocoded address, referral information, and cardiology clinic information. The primary outcome was an incomplete clinic visit. The secondary outcome was an unscheduled appointment. Independent associations were identified using multivariable logistic regression.

Results:

There were 10,610 new referrals; 6954 (66%) completed new cardiology clinic visits. Black race (OR 1.41; 95% CI 1.22–1.63), public insurance (OR 1.29; 95% CI 1.14–1.46), and a higher deprivation index (OR 1.32; 95% CI 1.08–1.61) were associated with higher odds of incomplete visit compared to the respective reference groups of White race, private insurance, and a lower deprivation index. The findings for unscheduled visit were similar. A shorter time elapsed from the initial referral to when the appointment was made was associated with lower odds of incomplete visit (OR 0.62; 95% CI 0.52–0.74).

Conclusion:

Race, insurance type, neighbourhood deprivation, and time from referral date to appointment made were each associated with incomplete referrals to paediatric cardiology. Interventions directed to understand such associations and respond accordingly could help to equitably improve referral completion.

Keywords

Paediatriccardiologyreferralhealth inequity
Type
Original Article
Information
Cardiology in the Young , Volume 34 , Issue 2 , February 2024 , pp. 428 - 435
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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