M. Mendez1, C. Krewson1,2, A. Taylor1, K. Kieran1 1Seattle Children’s Hospital, Urology, Seattle, WA, USA 2Pacific Northwest University of the Health Sciences, Yakima, WA, USA
Introduction: Differential access to care for patients living in more disadvantaged areas has been well documented, though the specific factors underlying these disparities have not been well described. We undertook this study to describe how clinic utilization and patient demographics differed before and after the utilization of a dedicated scheduler making outcalls for scheduling.
Methods: We identified all new patients seen in a single pediatric urology outreach clinic in March and April 2021 (prior to the scheduler being hired) and July and October 2021 and April, July and October 2022, and April 2023 (after the scheduler was hired). We recorded the overall clinic utilization for each fiscal year and also demographic data (including Area Deprivation Index [ADI]) on the new patients seen in clinic. Data before and after the hiring of the dedicated scheduler were compared.
Results: Scheduled clinic utilization increased from 93.6% in FY 2021 to 95.2% in FY2022 and to 98.9% in FY2023. Missed appointments were relatively stable at 7.4% in FY2021, 7.8% in FY2022, and 6.8% in FY2023. The number of new patients scheduled per month increased by 59% (62 vs. 39) after the addition of scheduling outcalls. The proportion of new patients living in the most disadvantaged areas (ADI 9-10) increased from 35.9% before the scheduler was hired to 61.3% after the addition of the scheduler (p=0.009), while the proportion of new patients living in the least disadvantaged areas (ADI 1-2) remained stable (2.6% vs. 4.8%, p=0.56).
Conclusions: Addition of a dedicated clinic scheduler making outbound calls increased clinic utilization durably and facilitated access primarily for patients living in the most disadvantaged areas. Further research is needed to identify what aspects of outbound scheduling are most helpful to the most vulnerable patients.