Abstract
Background: A missed primary care appointment is an independent
predictor of acute care utilization and suboptimal primary care
outcomes. However, the relationship between geographic proximity to
the primary care facility (PCF) and the risk of no-shows has not
been fully investigated in New York City. Objective of the study
was (1) to investigate the relationships of geographic proximity to
PCF with the risk of a no-show and (2) to explore/predict no-shows
based on a host of environmental and health system factors.
Methods: This was a single-center, retrospective study at General
Medical Associates (GMA)/Mount Sinai Beth Israel, a large, urban,
general internal medicine outpatient practice in lower Manhattan,
from January through December 2015. We calculated street network
distance to GMA in miles and transit time by public transportation
to GMA in minutes. A multivariable generalized estimating equation
regression model was used to analyze the relationships of
geographic proximity with missed facility appointments (i.e.,
no-show). Results: A total of 11,881 patients over 18 years old who
had appointments (total appointment = 36,144) at GMA from January
through December 2015 were included. Missed facility appointments
accounted for 21.2% of the total appointments. Median street
network distance and transit time were 4.4 miles and 23.9 minutes,
respectively. Fully adjusted models by multiple covariates showed
positive coefficient values in primary exposure variables ([transit
time] and [network distance]; 0.003 and 0.006, respectively) and
negative coefficient values in quadratic terms ([transit time]2 and
[network distance]2: -0.0001 and -0.0003, respectively) despite the
lack of statistical significance but trend of positive correlation
between transit time and risk of a no-show (p-values for
coefficients of [transit time], [network distance], [transit
time]2, and [network distance]2 in the full models were 0.052,
0.225, 0.053, and 0.581, respectively). The other significant
predictors of no-shows were younger age, male, black race,
Medicaid, resident/intern physician appointment, snowy weather, and
low annual household income. Conclusions: As the transit time by
public transportation to a PCF increases in New York City, patients
are more likely to have no-shows to facility appointments.
Table of Contents
Introduction page 1-2 Materials and methods Patients and other
clinical variables page 2-3 Statistical methods page 3-4 Results
Patient and appointment characteritics page 4-5 Main exposures of
no-shows page 5-6 Other predictors of no-shows page 6 Discussion
page 6-10 Conclusions page 10-11 Acknowledgement page 12 References
page 13-14 Table 1 page 15 table 2 page 16 Figure legends page 17
Figure 1 page 18 Figure 2 page 19 Figure 3 page 20 Figure 4 page 21
About this Master's Thesis
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