Sociodemographic Predictors of Missed Appointments Among Patients With Cleft Lip and Palate

Objective: To identify disparities in compliance of and care for patients with cleft lip and/or palate (CL/P) by determining the impact of sociodemographic variables on the rate of missed appointments and Child Protective Services (CPS) involvement. Design: A retrospective, noninterventional quality assessment and quality improvement study were designed. Setting: This institutional study was performed at the University of Michigan in Ann Arbor, Michigan. Patients: All patients born between January 1, 2011, and December 31, 2014, who underwent surgical CL/P repair, excluding those with fewer than 5 appointments (n = 178). Main Outcome Measure: The rate of missed appointments, calculated as the total number of no-show appointments divided by the total number of scheduled appointments. All appointments from CL/P diagnosis to data collection were considered, including those outside of plastic surgery. Results: The average patient was 4.5 years of age and had 49 total scheduled appointments. The overall rate of missed appointments was 9.6%, with 66.8% of patients missing at least 1 scheduled visit. Patients who were black (P = .04), not affiliated with a religion (P = .01), Medicaid users (P = .01), from an unstable social background (P = .01), or received need-based financial assistance (P = .00) were significantly more likely to miss appointments. Child Protective Services was involved with 3.9% of patients. Conclusions: Disparities exist in attendance rates among patients with CL/P, and at-risk patient populations have been identified. The allocation of cleft care resources must be efficiently planned in order to enhance the quality of care for at-risk individuals.