No-Show Rates in a Cardiology Clinic During the COVID-19 Pandemic: A Retrospective Analysis From a Safety-Net Hospital.

Background: The COVID-19 pandemic proved to be a formidable crisis leading to massive disruptions in healthcare delivery that compromised routine access to care across the United States. The strain of the pandemic on the healthcare system limited routine outpatient visits and regular follow-up for all patients. Patients struggling with social determinants of health (SDOH) have long suffered from limited access to healthcare and the pandemic exacerbated this issue. Patients with chronic cardiac conditions need regular follow-up to ensure the highest quality of care and limited outpatient accessibility can be highly disruptive to their health. Thus, patients with chronic cardiac conditions who also struggle with SDOH were a population that was particularly vulnerable to the strain of the pandemic.

Methods: A retrospective analysis was performed to assess the impact of the COVID-19 pandemic on the urban underserved patient population. Data were collected from the University Health System in Kansas City, MO, between 2019 and 2022. This safety-net hospital was selected because 66% of its patients are on Medicare, Medicaid, or uninsured, making its patient population a strong representation of the larger U.S. population struggling with SDOH. A report of in-person, outpatient cardiology visits scheduled during the specified timeframe was generated with demographic data and visit status. All visits scheduled that were completed or resulted in a no-show were included, with all other visits excluded. No-show rates were calculated overall and within each subgroup analyzed by dividing the number of no-shows by the total number of visits scheduled. No-show rates and percent change in no-show rates by year were analyzed for the whole population and stratified by gender, race, ethnicity, and insurance status.

Results: No-show rates increased in 12 out of 17 (71.0%) patient subgroups including male patients, Black patients, non-Hispanic patients, patients in the "other" category of ethnicity, those on a Self-Pay Discount Program, Medicaid, and Medicaid MC Plus. These groups all had no-show rates suggesting that nearly or greater than a third of their patients were not receiving the cardiovascular care they needed by the end of the pandemic. The highest no-show rates in 2022 were observed in the following patient subgroups: Black 1,915 (35.08%), Self-Pay Discount 490 (39.3%), Medicaid 873 (36.2%), and Medicaid MC Plus 689 (32.9%).

Conclusion: The COVID-19 pandemic significantly increased no-show rates for outpatient cardiology visits, particularly among underserved populations, highlighting the vulnerability of low socioeconomic status patients. This disruption in routine care underscores the need for continued development of strategies to ensure consistent healthcare access during crises. University Health System employs many outreach and other programs to help those struggling with SDOH and yet the strain of the pandemic was still seen. Other studies have demonstrated that telehealth may serve as a bridge to addressing care gaps in the underserved population. Further research is required to assess the short and long-term health impacts of missed appointments and to continue developing solutions for improving healthcare access in patients struggling with SDOH.