Daily Bulletin 2015

Patients are "Getting Lost in the System" Due to Socioeconomic Factors

Wednesday, Dec. 02, 2015

Efren J. Flores, M.D.

Efren J. Flores, M.D.

Evaluating socioeconomic factors impacting access to imaging services could help identify at-risk patients and devise intervention strategies to mitigate socioeconomic disparities associated with that lack of access, according to study presented Tuesday.

The motivation behind the study, said presenter Efren J. Flores, M.D., of the Department of Radiology at Massachusetts General Hospital (MGH), was a realization that a large number of imaging patients "are getting lost in the system" because of cultural differences, language barriers, mobility issues, and other socioeconomic factors.

"I had one patient who had missed a couple of appointments and finally made it in for a third appointment for an MRI," Dr. Flores said. "I found out that she had missed her previous appointments because we had left her reminder messages in English, which is not her primary language. So it made me think about how many other patients are missing appointments—or just aren't being connected to the healthcare system—because we aren't providing diverse care or aren't sensitive enough culturally."

This look at the socioeconomic factors impacting imaging access has also led to a change in the way Dr. Flores and his colleagues describe events like missed appointments.

"The no-show term places the responsibility solely on the patient," Dr. Flores said. "But we suggest the term 'missed care opportunity' or MCO. MCO accounts for the provider's responsibility in assuring the provision of care and therefore not delaying care to their patients."

Dr. Flores pointed out that while racial disparities are known to exist in medicine, they haven't been broadly studied in radiology. "We wanted to assess the demographic factors behind MCO, get a better understanding of our patients' social genome, and the impact on radiology services," he said.

For their study, Dr. Flores and his colleagues collected data on 975,539 ordered radiologic imaging examinations at MGH during 2014. The data included information on ethnicity/race, primary language, insurance status, and reasons for a canceled appointment. They also collected Boston city census data, such as employment and income, as well as data from Google Maps for geo-coding.

According to the study, missed care opportunity was the most common reason that patients failed to complete a radiologic examination. Overall, about 5 percent of radiology appointments in 2014 resulted in an MCO. The researchers found that lower incomes, a primary language other than English and Black or Hispanic patients were significantly associated with greater odds of an MCO for a radiology appointment.

Dr. Flores said the results suggest that data is available to develop a predictive model that can be used to identify risk factors for missed care opportunities for patients and suggest personalized strategies to help those patients, such as coordinating transportation or providing discharge instructions in their native language.

Socioeconomic disparities do exist in radiology, Dr. Flores concluded. "We are responsible for patient engagement and believe that patient experience starts as soon as the exam is ordered—not in the parking lot, not in the waiting room, but as soon as that exam is entered into the system. We need to focus on diverse and equitable healthcare, ensure that patients have fair access to all the services we provide, and we need to leverage technology to ensure that no patient is left behind."

Question of the Day:

I am treating a patient for thyroid cancer with Iodine 131. He makes pasta for a living and wants to know when he can go back to work.

Tip of the day:

Tendons and ligaments may experience "magic angle artifacts" caused by very short T2 times when the tightly bound collagen is at ~55 degrees from the main magnetic field.

The RSNA 2015 Daily Bulletin is owned and published by the Radiological Society of North America, Inc., 820 Jorie Blvd., Oak Brook, IL 60523.