ARRS 2022 Abstracts

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E1725. Understanding and Improving Access to Radiology for the Underserved Population
Authors
  1. Mensur Koso; Ohio State University College of Medicine
  2. Selina Vickery; Ohio State University College of Medicine
  3. Summit Shah; Nationwide Children's Hospital
Objective:
Barriers to accessing radiological services are accentuated in underserved populations. Radiology utilization and access for this population, which includes a large number of immigrant and uninsured patients, has rarely been studied. This study analyzes radiology referral patterns from a large free clinic and presents interventions to improve access.

Materials and Methods:
Radiology referrals from a large student-run free clinic were analyzed by success rate, imaging modality, clinical indication, and demographics. All referrals were sent to a large tertiary academic hospital. A successful referral was defined as a completed imaging examination with report. Referrals were predominantly funded through the hospital’s Health Care Assurance Program (HCAP) and state-run mammogram assistance program.

Results:
There were 422 radiology referrals over 4 years from 2017–2020. This represented 30% of all referrals (n = 1,427), and radiology was the highest specialty referral. Overall, 54% (226) were successful. Success rates were 52% (129, 31% of total) for x-rays, 61% (118, 28% of total) for ultrasound, 43% (100, 24% of total) for mammograms, 51% (35, 8% of total) for CT, 86% (22, 5% of total) for MRI, 44% (9, 2% of total) for echocardiogram, 38% (8, 2% of total) for DEXA bone scan, and 0% (1, 0.2% of total)for nuclear thyroid scintigraphy. Success rate for x-rays and ultrasound referrals decreased in 2020 (25% and 28%, respectively) along with the number of total radiology referrals in 2020 (87 compared to 130 in 2019). Success rate for mammograms, however, was unchanged in 2020 (42%). The most common indication for ultrasounds was female pelvic concerns (22), for CTs it was lung cancer screening (7), and for MRI it was lumbar back pain (5). Additional indications for ultrasound included right upper quadrant pain (18), thyroid concerns (16), breast concerns (10), and deep vein thrombosis (9). Demographically, the patient population was diverse with 74% (313) of radiology referrals submitted for patients who were not White. Additionally, 35% (146) of referrals were submitted for patients who did not speak English as a primary language. There was a 2:1 (278:144) female to male referral ratio.

Conclusion:
Radiological referrals represent the largest specialist referrals from our underserved free clinic population, but nearly half were unsuccessful. This was further negatively impacted during the COVID-19 pandemic. Mammograms, however, were not negatively affected in 2020, which may be due to the presence of patient navigators. In addition to direct patient contacts, patient financial assistance programs, offering point of care ultrasound services, and improving communication and transportation barriers were identified as the most important factors to improving access to radiology services. Focusing on these interventions may improve care for the underserved population.