195 - Identifying Disparities in Referral Completion to Improve Access to Pediatric Specialty Care

Poster Number: 195
Publication Number: 195.319

Anisha P. Srinivasan, Seattle Children's Hospital / University of Washington, Seattle, WA, United States; Alicia A. Adiele, Seattle Children's Hospital, Seattle, WA, United States; Shaquita Bell, Seattle Children's Health System - OBCC, Seattle, WA, United States; Arti D. Desai, University of Washington School of Medicine, Seattle, WA, United States; Erin Sullivan, Seattle Children's, Seattle, WA, United States; K. Casey Lion, University of Washington School of Medicine, Seattle, WA, United States

Background: Disparities exist in access to pediatric subspecialty care. The extent to which the referral and scheduling process contributes is poorly understood.

Objective: To determine whether sociodemographic factors are associated with appointment scheduling and completion in a cohort of pediatric specialty referrals.

Design/Methods: This was a retrospective cohort study of patients referred to specialty care at a large children's hospital from 03/01/19 – 03/31/21. Referrals from pediatric clinics within 5 miles of the hospital were included to create a cohort without significant geographic access barriers. Linear regression models tested for associations between demographic variables (race and ethnicity, language, insurance type, and neighborhood Area Deprivation Index (ADI), serving as proxies for racism, discrimination, and their downstream effects) and odds of scheduling and completing a referral. Cox proportional hazard models were used to assess time to appointment scheduling and completion. Multivariable analyses controlled for specialty referral volume, patient age, and referral clinic to account for within-clinic correlation.  

Results: Of the 38,334 new referrals, 62% resulted in appointment scheduling and 54% resulted in completion (Table 1). For patients with Spanish language for care, public or other insurance, or Black race, less than 50% of referrals resulted in a completed appointment. In adjusted analyses, some race and ethnicity groups (Asian, Black, and Multiracial or Other) and public or other insurance were significantly associated with lower odds of both scheduling and completing referrals (Table 2), with adjusted odds ratios ranging from 0.64 to 0.92. Using a language other than English and public insurance were significantly associated with a lower hazard ratio for time to scheduling and completing appointments, indicating longer times to each outcome (Table 3). Conclusion(s): Significant disparities exist in the odds and timing of referral scheduling and completion by race and ethnicity, insurance, neighborhood type, and language, for a cohort of children from clinics local to the referral center. This variation indicates a scheduling and referral process that disproportionately excludes families who may experience socioeconomic hardship, racism and discrimination, or language barriers. Interventions to simplify and enhance the inclusiveness of the referral process may help to reduce disparities in accessing pediatric specialty care.
Anisha Srinivasan CV.pdf
Odds of Referral Resulting in Scheduled Appointment and Odds of Referral Resulting in Completed Appointment