Research In Practice Blog
Editor’s Note: This work was published online by JAMA Network Open on April 27, 2026, 10AM CT, the timing corresponded with the “Associations of Extreme Temperatures with Missed Pediatric Preventive Visits Session: Environmental Health” presentation at the 2026 Pediatric Academic Societies (PAS) Meeting in Boston, MA.
Summary Statement:
In their new study, published in JAMA Network Open, researchers from Children’s Hospital of Philadelphia (CHOP), including Clinical Futures and PolicyLab experts Drs. Stephanie Mayne, Brian Jenssen, and Alex Fiks, explore the correlation between extreme temperatures and missed pediatric preventive visits. Although prior studies in pediatric populations have demonstrated that extreme temperatures, especially extreme and excessive heat, are associated with higher rates of emergency department visits among children, this is the first study of its kind to determine association of extreme temperature with primary care visits.
How this study was performed:
It is well known that missed pediatric preventive visits can lead to delays in completing essential developmental screenings, missed immunizations, and poor management of chronic conditions, which can adversely affect children’s health. Missed pediatric preventive visits are influenced by a variety of factors, which provide an opportunity for researchers to address these challenges effectively. Research has shown that certain sociodemographic factors play a role in the rates of missed primary care visits. Older children, those with public insurance, and families facing food insecurity or other unmet social needs often have higher rates of missed appointments.
To better understand and reduce the number of missed preventive visits due to extreme temperatures, researchers designed a cross-sectional observational time-series study involving 4,137,542 preventive visits from 504,428 patients conducted within the Pediatric Research Consortium (PeRC), which is CHOP’s primary care practice-based research network. This research network encompasses 32 primary care practices in the Philadelphia metropolitan area, covering southeastern Pennsylvania and southern New Jersey. Researchers extracted data from CHOP’s electronic health records for all scheduled in-person preventive care visits among patients under 19 years old in the CHOP primary care network from January 1, 2009, to December 31, 2023.
Study Findings:
Overall, the rate of missed preventive visits was higher on days with both hot and cold temperatures, relative to the overall median temperature. Within the study population, the percentage of missed visits was higher among non-commercially insured children and those from low socioeconomic status (SES) neighborhoods, while children under the age of 2 had lower rates of missed visits compared to older children. Consistent with these findings, researchers initially hypothesized that the relationship between extreme temperatures and missed preventive visits would be stronger among publicly insured patients and those from low-SES neighborhoods, as this population might face greater transportation challenges influenced by weather conditions. However, results showed the opposite trend during cold months: commercially insured children and those living in neighborhoods with greater opportunities had a stronger correlation between colder temperatures and missed preventive visits. This may suggest that the higher baseline rates of missed visits among non-commercially insured children and those from very low-SES neighborhoods are driven by factors unrelated to temperature, making them less sensitive to weather changes. Conversely, the impact of temperature on missed appointments was more pronounced among demographic subgroups with lower baseline rates of missed visits, such as commercially insured individuals and children from high-SES neighborhoods. Families with higher SES might have more flexibility to reschedule appointments, whereas lower-SES families may feel compelled to attend appointments even in extreme temperatures due to limited availability or challenges in taking time off from work. Future qualitative research is needed to explore the underlying factors contributing to these differences.
What this research adds:
“These research findings indicate that extreme temperatures can lead to a rise in missed pediatric primary care visits. To address this challenge, hospitals and clinics can proactively prepare for the anticipated increase in frequency and intensity of extreme temperatures. By developing effective mitigation strategies, healthcare systems can minimize the impact of these conditions on patient access to care and ensure that children receive the support they need,” said Dr. Stephanie Mayne, lead author of the study and Associate Director of Clinical Epidemiology at Clinical Futures.
Clinical Implications:
To address the potential impacts of extreme temperatures on attendance at primary care appointments, healthcare practices might consider implementing several strategies. One effective approach could be to expand telemedicine services during periods of extreme temperatures. Research shows that telehealth appointments can reduce the likelihood of missed appointments for both children and adults. However, it’s important to note that not all preventive care services, such as vaccinations, can be provided through telehealth.
Future studies are needed to evaluate the effectiveness of converting missed appointments into telehealth visits when extreme temperatures occur. Additionally, practices could explore solutions to assist patients who face transportation challenges, such as partnering with rideshare services to facilitate access.
Another strategy could involve establishing weather-monitoring systems that prompts proactive outreach to patients who have scheduled appointments when extreme weather is anticipated. This outreach could include offering flexible rescheduling options. Furthermore, implementing flexible scheduling policies, such as reducing cancellation penalties for same-day cancellations during extreme weather or increasing appointment availability in the days following extreme temperature events, may help patients continue to access essential preventive care.
About PeRC:
The Pediatric Research Consortium (PeRC), was launched in 2002 with funding from the Agency for Healthcare Research and Quality. PeRC brings together epidemiologists and health services researchers, clinical informaticians, and administrators to organize and support clinical research projects aimed at improving the safety, quality, and outcomes of pediatric care.
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