Telemedicine and Missed Appointments Among Pediatric Patients of an Academic Safety-Net System

<b>Background:</b> Missed appointments adversely affect clinical outcomes, clinic efficiency, and quality of care and could worsen the impact of pediatric workforce shortages on health care access. Telemedicine has the potential to reduce missed appointments. However, interventions that do not account for neighborhood factors could widen disparities. We analyzed the relationship between missed appointments and type of pediatric appointment and the role of telemedicine and neighborhood factors. <b>Methods:</b> This retrospective cohort study used three data sources: (1) electronic health records, (2) American Community Survey, and (3) Housing and Urban Development crosswalk data. The analyses were restricted to pediatric patients (<18 years) with completed or missed outpatient visits (March 2020-December 2022). The outcome was missed appointments. The primary predictors were pediatric visit type, appointment modality, census tract (CT) residential segregation, and CT poverty level. Generalized estimating equations were used. <b>Results:</b> The final sample size was 90,712 appointments for 32,305 unique patients. The overall no-show rate was 20.75%. The no-show rate for general pediatrics was 20.36% and 27.82% for specialty appointments. In multivariable analyses, there was an increased likelihood of missed appointments for pediatric subspecialty appointments compared to general pediatrics (Odds Ratio (OR): 1.62; 95% Confidence Interval (CI): 1.51, 1.74). Telemedicine appointments were associated with a decreased likelihood of missed appointments compared to in-person appointments (OR: 0.41; 95% CI:0.39, 0.44). There was a positive interaction between appointment type and pediatrics visit type with a larger effect for subspecialty visits. <b>Conclusions:</b> Tailored interventions that integrate telemedicine uptake and contextual factors have the potential to reduce missed appointments.