Association of Child Opportunity Index 3.0 With Imaging Missed Care Opportunities in Ambulatory Pediatric Nuclear Medicine Examinations.

Abstract

There is a paucity of data on missed imaging appointments, also known as imaging missed care opportunities (IMCOs), in pediatric nuclear medicine (NM) and related sociodemographic factors, specifically, Child Opportunity Index (COI), a composite measure of US neighborhood resources linked to healthy child development. COI levels group neighborhoods into quintiles: very low, low, moderate, high, and very high opportunity. The primary aim was to examine association of COI with IMCOs for ambulatory pediatric NM examinations and secondarily assess other sociodemographic factors affecting IMCOs. Retrospective single-center cross-sectional review was performed of outpatient pediatric NM examinations (patient age ≤ 21 years) from 2017 to 2022, after institutional review board approval. The primary outcome was IMCOs (patient nonarrival; incomplete appointment upon arrival; or non-provider-driven cancellation ≤ 1 day before the appointment). The primary exposure was COI 3.0 level. Covariates included patient (age, gender, race or ethnicity, language, insurance, and residency type) and appointment factors (imaging group, year, season, and wait days). Univariate and multivariable analyses were performed, with P < .05 considered statistically significant. Seven thousand six hundred twenty patients (12,864 appointments) met inclusion criteria. Median age (interquartile range) was 8 years (3-15), and 920 (7.2%) appointments resulted in IMCOs. There were 66% higher odds of IMCOs for patient appointments from zip codes with very low or low compared with very high COI levels (P < .001). Other predictors of IMCOs were age (P = .020), race or ethnicity (P = .026), insurance (P < .001), season (P < .001), and imaging group (P < .001). COI was significantly associated with IMCOs for pediatric NM examinations. Interventions are needed to reduce imaging inequities and IMCOs from lower-opportunity neighborhoods.