(0252) Sociodemographic and System Factors Associated With Appointment Nonattendance and Surgical Conversion Among Cochlear Implant Candidates

Introduction: Cochlear implant (CI) surgery is underutilized. Barriers to attending CI evaluation appointments may perpetuate this finding. Thus, the study objective is to identify factors associated with no-show appointments among CI candidates.

Methods: This is a retrospective cohort study at a tertiary healthcare center. Medical records of 491 adult patients scheduled for CI evaluation between 2021-2023 were reviewed. A chi-square test was utilized to measure no show rate, CI procedure completion rate, and time from referral to no-show appointment.

Results: Between 2021-2023, 19.7% (n=97) CI candidates missed at least one evaluation appointment; of which 61.0% were 50 years of age or older, 72.0% were Hispanics and 52.0% had a history of cardiovascular disease. Outside referrals were associated with longer wait times (48.5 vs. 37.0 days to no-show appointment; p=0.03). Patients with Medicare (p=0.03) and without MyChart (p=0.02) also had extended wait times. Appointment rescheduling rate after a missed appointment was significantly lower among young adults compared to older candidates (66.7% vs 86.0%; p=0.001). Factors associated with high rates of surgical conversion were: younger adults (40.7%, p=0.04), Hispanic identity (50.0% vs. 33.3%; p=0.003) and MyChart access (44.7% vs. 21.3%; p=0.02).

Conclusions: Healthcare system elements such as insurance type, external referral processing and MyChart access may hinder CI candidates from attending evaluation appointments. Interventions targeted at improving these systemic barriers, particularly among elderly and minority groups, may improve appointment adherence and implantation rate.