Glover 2017


Year: 2017

Title: Socioeconomic and Demographic Predictors of Missed Opportunities to Provide Advanced Imaging Services

Country: United States

Age: Adult Only

Sex: All Sexes

Population: Multiple Groups

Care Setting: Outpatient Ambulatory and Primary Care

Clinical Setting: General Diagnostic Imaging

Data Level: Single Institution

Data Type: EHR

Data Source: Local data

Conclusion: Disparities In Some Minority Groups

Health OutComes Reported: No

Mitigation: No

Free Text Conclusion: Black and Hispanic patients had a greater likelihood of having a "imaging missed care opportunity."

Abstract: Purpose: The extent to which racial and socioeconomic disparities exist in accessing clinically appropriate, advanced diagnostic imaging has not been well studied. This study assesses the relationship between demographic and socioeconomic factors and the incidence of imaging missed care opportunities (IMCOs). Methods: We performed a retrospective review of outpatient CT and MRI appointments at a quaternary academic medical center and affiliated outpatient facilities during a 12-month period. Missed appointments not rescheduled in advance were classified as IMCOs. Appropriateness criteria scores and demographics were also obtained. Univariate and multivariate analyses were performed to determine if demographic and socioeconomic factors were predictive of IMCOs. Results: Overall, 57,847 patients met inclusion criteria, representing 89,943 scheduled unique imaging appointments of which 5,840 (6.1%) were IMCOs; 0.8% of IMCO appointments had low appropriateness scores compared with 1.2% of completed appointments (P < .01). Appointments covered by commercial insurance (5.2%) had significantly lower rate of IMCOs than other payers: Medicare = 6.3%, Medicaid = 14.5%, self-pay = 12.0% (P < .05). The following factors were independent predictors of a patient having >= 1 IMCO: noncommercial insurance [odds ratio (OR) = 1.7-2.6], African American (OR = 1.8), Hispanic (OR = 1.2), other race (OR = 1.1), language other than English or Spanish (OR = 1.2), male gender (OR = 1.2), age >= 65 (OR = 0.71), and median household income of patient home zip code <$50,000 (OR = 1.4). Conclusions: Race and socioeconomic status are independent predictors of IMCOs. In efforts to enhance patient engagement, radiologists should be aware of the impact of race and socioeconomic status on access to clinically appropriate advanced diagnostic imaging.