Title: Sociodemographic and Appointment Factors Affecting Missed Opportunities to Provide Neonatal Ultrasound Imaging
Country: United States
Age: Pediatric Only
Sex: All Sexes
Population: Multiple Groups
Care Setting: Outpatient Ambulatory and Primary Care
Clinical Setting: General Diagnostic Imaging
Data Level: Single Institution
Data Type: EHR
Data Source: Local data
Conclusion: Disparities In Some Minority Groups
Health OutComes Reported: No
Free Text Conclusion: Imaging missed care opportunities were more likely for Black, Latinx, and other-race neonates.
Abstract: PURPOSE: The aim of this study was to assess disparities in outpatient imaging missed care opportunities (IMCOs) for neonatal ultrasound by sociodemographic and appointment factors at a large urban pediatric hospital. METHODS: A retrospective review was performed among patients aged 0 to 28 days receiving one or more outpatient appointments for head, hip, renal, or spine ultrasound at the main hospital or satellite sites from 2008 to 2018. An IMCO was defined as a missed ultrasound or cancellation <24 hours in advance. Population-average correlated logistic regression modeling estimated the odds of IMCOs for six sociodemographic (age, sex, race/ethnicity, language, insurance, and region of residence) and seven appointment (type of ultrasound, time, day, season, site, year, and distance to appointment) factors. The primary analysis included unknown values as a separate category, and the secondary analysis used multiple imputation to impute genuine categories from unknown variables. RESULTS: The data set comprised 5,474 patients totaling 6,803 ultrasound appointments. IMCOs accounted for 4.4% of appointments. IMCOs were more likely for Black (odds ratio [OR], 3.31; P <.001) and other-race neonates (OR, 2.66; P <.001) and for patients with public insurance (OR, 1.78; P = .002). IMCOs were more likely for appointments at the main hospital compared with satellites (P <.001), during work hours (P = .021), and on weekends (P <.001). Statistical significance for primary and secondary analyses was quantitatively similar and qualitatively identical. CONCLUSIONS: Marginalized racial groups and those with public insurance had a higher rate of IMCOs in neonatal ultrasound. This likely represents structural inequities faced by these communities, and more research is needed to identify interventions to address these inequities in care delivery for vulnerable neonatal populations.