Determinants of Appointment Completion in Rehabilitative Care: The Role of Insurance, Program Structure, and Access Barriers.

DETERMINANTS OF APPOINTMENT COMPLETION IN REHABILITATIVE CARE The Role of Insurance, Program Structure, and Access Barriers OBJECTIVE: Examine factors predicting healthcare appointment completion at Shepherd Center. Factors included sex, sex, race, ethnicity, geographic location, level of rurality of residence, state of residence, appointment lead time, type of healthcare insurance, patient classification, COVID-19 era, and telehealth as predictors to appointment completion.

DESIGN Bivariate analyses and binary logistic regressions were conducted on a dataset on patient visits. Data were retrieved from Shepherd Center's patient portals.

PARTICIPANTS Patients with at least one healthcare appointment at Shepherd Center between March 19, 2020, and February 28, 2025 (N=19,453). Main unit of analysis was healthcare appointments (N=1,105,752).

MAIN OUTCOME MEASURE Healthcare appointment completion.

RESULTS Insurance type and visit department significantly predicted appointment completion. Compared to private, public (B=-0.352), self-pay (B=-0.174), and other insurance types (B=-3.711) were associated with lower odds of completion (p<0.001). Medical visits had increased odds of appointment completion (B=1.301), while occupational therapy (B=-0.953), physical therapy (B=-0.703), speech-language pathology (B=-0.943), and psychology departments (B=-1.025) reduced odds for appointment completion (p<0.001). Telehealth occurred as a positive predictor of appointment completion in early models (B=0.328-0.426, p<0.001). However, when accounting for insurance and departments, it lowered completion odds. Sociodemographic variables did not strongly predict appointment completion (B=-0.962, p<0.001).

CONCLUSION While sociodemographic factors were significant predictors of appointment completion, healthcare insurance type and appointment department emerged as the strongest predictors. Financial security and access to healthcare are foundational to patient engagement in rehabilitation settings. To improve appointment completion and promote equitable access to rehabilitation services, healthcare systems must adopt multifaceted strategies that address underlying financial, administrative, and accessibility challenges.