OBJECTIVES: The study objective was to describe the distribution of missed primary care appointments and to evaluate the association between social determinants of health and missed appointments among high-risk Medicaid enrollees in the Medical Home Network (MHN) accountable care organization.

METHODS: This study included adults enrolled in the Medicaid accountable care organization and eligible for care management with one or more primary care appointments scheduled within an academic medical group between January 2018 and December 2018. Enrollees completed a health risk assessment that included self-reported social and community barriers to care, including lack of transportation; difficulty paying for medications; needing help making appointments; needing health in getting food, clothing or housing; and living alone. The number and proportion of missed appointments were calculated for each enrollee. Generalized linear regression was used to examine the relationship between missed appointments and patient demographic and clinical characteristics and social determinants of health.

RESULTS: The sample included 723 patients with a total of 2,857 scheduled appointments, including 707 (24.7%) missed appointments. The mean number of scheduled appointments per enrollee was 4.0 (sd = 3.5), with 1.0 (sd = 1.5) missed appointments. While 50% of the enrollees had no missed appointments, 6% had 4 or more missed appointments, accounting for 33% of the total missed appointments. After adjusting for patient characteristics, enrollees who lacked transportation to their appointments had 0.30 (95% CI: 0.02, 0.58) more missed appointments than enrollees who had access to transportation, and enrollees qualifying for Medicaid due to disability had 1.08 (95% CI: 0.29, 1.87) more missed appointments if they did not have access to transportation.

CONCLUSIONS: Future interventions designed to increase appointment completion should target patients with multiple no-show appointments and those who report transportation barriers, particularly older adults and those with a disability.