(P03-011-24) Predictors of Missed Pediatric Dietitian Clinic Visits

Objectives: Registered dieticians (RDs) have a critical role in providing individualized nutritional counseling to address pediatric overweight, obesity, and other nutritional conditions disproportionately impacting children from disadvantaged backgrounds. Though attendance of scheduled RD visits is essential in addressing these disparities, there is a paucity of literature investigating the prevalence or predictors of missed clinic visits (MCV) with registered dieticians. Our objective was to examine the overall RD MCV prevalence at a comprehensive, multi-site practice and characterize predictors of these MCV events.

Methods: This retrospective study included all missed or completed outpatient RD visits at Boston Children’s Hospital from January 2016, to May 2022. Univariate and multivariate hierarchical generalized linear mixed models were employed to identify associations between visit- and patient- level predictors and an MCV outcome.

Results: 61,778 visits from 12,757 individual patients residing in Massachusetts were included in this study. The overall MCV rate was 17.1%. Multivariate analyses, controlling for multiple predictors of significance, demonstrated a higher odds ratio (OR) of MCV for patients self-identifying with minority race and ethnicity status (OR 3.29 [95% confidence interval 2.95-3.66]). Compared to in-person (IP) visits, telemedicine (TM) was associated with higher MCV odds for patients self-identifying with minority race and ethnicity status (OR 4.8 [4.03-5.6]), those with a language preference other than English (IP OR 1.27 [1.06-1.51]; TM OR 1.95 [1.43-2.67]), those with increasing Social Vulnerability (IP OR 1.56 [1.4-1.75]; TM OR 2.25 [1.9-2.67]), and those utilizing public insurance (IP OR 1.96 [1.76-2.17]; TM OR 2.25 [1.9-2.67]).

Conclusions: We found strong associations between RD MCVs and visits for pediatric patients at the highest risk of obesity and other nutritional conditions impacted by sociodemographic disparity. Telemedicine utilization was associated with worsening MVC odds for these already vulnerable patients, underscoring the need for re-evaluation of the most effective RD-based clinical care interventions.

Funding Sources: None