medical access Archives - The Imaging Wire

Amid concerns about equitable access to healthcare, questions have arisen about imaging deserts – U.S. regions without any access to radiology services. A new study in Academic Radiology probes the issue, finding that it may not be as bad as originally feared – for reasons unique to radiology.

Uneven access to healthcare – particularly in rural regions – has become a common refrain in analyses of the U.S. healthcare system.

In radiology, the issue has reached into the debate over workforce shortages as open jobs go unfilled in rural areas while urban positions are snapped up quickly – a trend one job board dubbed “geographic inconvenience.”

But how common is a complete lack of access to imaging? And what are the correct public policy tools to address it?

In the new study, researchers assessed imaging availability in U.S. counties by determining whether imaging equipment, local radiologists, or both were available.

In their analysis of 3.1k U.S. counties covering 340.1M residents, researchers found…

Only 1.9% of Americans (6.4M people) lived in true imaging deserts, where there was neither installed imaging equipment nor a local practicing radiologist.
7.6% of Americans (25.9M people) lived in counties with an installed scanner but no local radiologist.
0.1% lived in a county with a local radiologist but no equipment.
90% (307.4M) were considered “fully served” by imaging, with local image acquisition available and some kind of remote interpretation possible.

The statistics point to radiology’s advantage over other medical specialties that require doctors to be physically present to deliver care.

Thanks to teleradiology, images can be acquired locally with installed equipment and then transmitted to central hubs for interpretation.

But even if less than 2% of the population lacks access, 6.4M Americans is a lot of people. How does living in an imaging desert affect their access to radiology?

Researchers found that imaging use rates were 6% lower in imaging deserts compared to fully served regions, while Medicare payments per beneficiary were 8.9% lower.

The Takeaway

The new findings on regional access to imaging show that while most Americans have good access to radiology services, more work is needed to improve care for those who don’t. This is particularly true for services like interventional radiology that require radiologists to be present.

Patients from disadvantaged neighborhoods or those traveling farther for brain MRI scans presented in worse clinical condition than patients with better access. That’s according to a new JACR study that reopens the debate over disparities in healthcare access.

The past several years have seen numerous studies published that document disparities in healthcare access and their impact on clinical outcomes.

In radiology, most of the focus has been on screening exams for breast and lung cancer, while other research has pointed to possible solutions to improve access.

Many previous studies have also concentrated on access to care in rural areas, in which long distances make it harder for patients to travel to medical centers.

In the current study, researchers led by authors from Emory University flipped the script to examine care access in the Atlanta metropolitan area in an effort to quantify how distance and socioeconomic status might impact patient care.

They examined the demographic backgrounds of 4.8k patients who got brain MRI scans over a one-year period starting in March 2019, calculating factors like distance from home to imaging facility and socioeconomic status based on the area deprivation index.

They then correlated these data to patient illness severity – also known as acuity – when they presented for their scans, using a three-point scale ranging from normal (level 1) to findings requiring a change in patient management (level 3).

Based on the data, researchers found…

Patients in neighborhoods with lower socioeconomic status had 34% higher odds of level 2 acuity versus level 1 for inpatient scans and 27% higher for emergency scans.
Patients living twice the distance from an imaging facility had 6.5% higher odds of level 2 acuity compared to level 1, and 15% higher for level 3.
Other factors affecting acuity level included age, race, and insurance status.
Medicaid recipients in particular were sicker, with 68% higher odds of acuity level 2 and 81% higher odds of acuity level 3 compared to those with commercial insurance.

The findings track with other studies that have linked chronic health conditions with brain pathologies, such as the connection between diabetes and stroke.

The Takeaway

The new findings offer additional details on how patient demographics affect both their health status and their access to care, in particular for advanced imaging scans like brain MRI. Follow-up studies could examine whether a similar phenomenon occurs with CT, which is the workhorse modality for emergency imaging.

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