Disparities in Pediatric Specialty Referral Scheduling and Completion - 08/09/23
, Erin Sullivan, MPH 2, Arti Desai, MD, MSPH 2, 3, Alicia Adiele, MSW 2, Shaquita Bell, MD 2, 3, K. Casey Lion, MD, MPH 2, 3Abstract |
Objective |
To estimate differences in scheduled and completed specialty referrals by race, ethnicity, language for care, and insurance type.
Study design |
We studied a retrospective cohort of 38 334 specialty referrals to a large children's hospital between March 2019 and March 2021. We included referrals for patients with primary care clinics within 5 miles of the hospital. We examined whether the odds of and time to scheduled and completed referrals differed by patient sociodemographic characteristics.
Results |
Of all referrals, 62% were scheduled and 54% were completed. Referral completion rates were lower for patients with Black race (45%), Native Hawaiian/Pacific Islander race (48%), Spanish language (49%), and public insurance (47%). Odds of scheduled and completed referral were lower for Asian (aOR scheduled: 0.94, [95% CI: 0.89, 0.99]; aOR completed: 0.92 [0.87, 0.97]), Black (aOR scheduled: 0.86 [0.79, 0.94]; aOR completed: 0.80 [0.73, 0.87]), and publicly insured patients (aOR scheduled: 0.71 [0.66, 0.75]; aOR completed: 0.70 [0.66, 0.75]). Time to scheduled and completed referral was longer for Black (adjusted hazard ratio [aHR] scheduled: 0.93 [0.88, 0.98]; aHR completed: 0.93 [0.87, 0.99]) and publicly insured patients (aHR scheduled: 0.85 [0.82, 0.88]; aHR completed: 0.84 [0.80, 0.87]) and families with a language other than English (aHR scheduled: 0.66 [0.62, 0.70]; aHR completed: 0.92 [0.86, 0.99]).
Conclusions |
Within a geographically homogenous pediatric population, the odds and time to scheduled and completed specialty referrals differed by sociodemographic characteristics, suggesting the effects of discrimination. To improve access equity, health care organizations need clear and consistent referral workflows and more comprehensive metrics for access.
Le texte complet de cet article est disponible en PDF.Keywords : Access, discrimination, healthcare disparities, language barriers, pediatrics, racism, referral, scheduling, specialty care
Abbreviations : ADI, aHR
Plan
| Portions of the study were presented as a poster at the Pediatric Academic Societies Conference, April 24, 2022, in Denver, Colorado. Portions of this study were also reported as part of Dr Srinivasan's thesis dissertation for a master's degree at the University of Washington; the thesis is under embargo until July 13, 2024 but will eventually be available on ProQuest databases online. |
Vol 260
Article 113485- septembre 2023 Retour au numéro
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