The Impact of Waiting Time and Treatment Modality: An Empirical Analysis of a Pediatric Speech-Language Therapy Program

Abstract

Demand for multi-appointment, outpatient care services is high and growing, pressuring overburdened healthcare systems and highlighting the need for operational improvements. In this study, we investigate operational and scheduling-related factors, and their impact on the number of appointments patients require to be discharged, as well as their appointment attendance behaviour. We first utilize data from over 1,700 pediatric speech-language therapy patients to study the associations between waiting time for service, treatment modality, and the number of appointments patients require. Using a continuation ratio model, we estimate that, on average, each additional year a patient waits to begin treatment is associated with a 26.3\% increase in the total number of appointments needed. Furthermore, we show that offering all appointments in-person, versus via telemedicine, patients require 8\% fewer total visits to achieve their desired outcomes. While these are the average effects across the patient population, we also find significant differences between patients of different severities and the relationships between waiting time, modality, and the number of appointments needed. Secondly, we use a mixed-effects multinomial logistic regression to investigate the relationship between appointment modality and appointment attendance. Although in-person treatment is associated with patients requiring fewer total appointments to achieve desired outcomes, in-person appointments are also 4.42\% less likely to be attended. This highlights the need for management to consider the effects of scheduling decisions on multiple drivers of system throughput.