Factors Affecting Medical Appointment Adherence among Adolescents and Young Adults with Kidney Disease: A Longitudinal Cohort Study

To identify patient-, health-, and visit-level factors associated with medical appointment adherence (MAA) among adolescents and young adults (AYAs) with pediatric-onset chronic kidney conditions, and to assess whether multiple pre-scheduled appointments on the same day (“bundling”) and preceding disease severity influence attendance and disparities. Retrospective longitudinal cohort study using electronic medical record data from a single academic children’s hospital (2005–2015). AYAs (n=353) with chronic kidney disease or systemic illnesses affecting the kidney had 37,371 scheduled outpatient appointments. The outcome was MAA (completed, cancelled, no-show). Covariates included demographics (e.g., age, sex, race/ethnicity, insurance), disease characteristics (e.g., recent eGFR, transplant status), and appointment features (e.g., time since last visit, clinic type, weather). Multinomial logit models with patient-level clustering were estimated, stratified by disease severity and by single vs multiple appointments per day. No-show rates were higher among African American patients and those with Medicaid or self-pay insurance. Older age was also associated with lower adherence. On days with multiple scheduled appointments, overall attendance improved and insurance-related disparities were attenuated; among Medicaid patients, no-show differences observed on single-appointment days were reduced on bundled days. Findings were directionally consistent across disease-severity strata. Having ≥2 scheduled appointments on the same day is associated with improved attendance and reduced disparities in AYAs with chronic kidney conditions. Health-system strategies that facilitate appointment bundling (e.g., co-locating services and coordinated scheduling) could be a pragmatic quality-improvement target to improve equity and continuity of care.