Department of Radiology and Imaging Sciences, Division of Emergency and Trauma Imaging, Emory University Mid-town Hospital, 550 Peachtree Rd, Atlanta, GA 30308.
Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
AJR Am J Roentgenol. 2021 Feb;216(2):519-525. doi: 10.2214/AJR.20.23161. Epub 2020 Dec 23.
The purpose of our study was to assess potential disparities in the utilization of advanced imaging during emergency department (ED) visits. This retrospective study was conducting using 5% Research Identifiable Files. All CT and MRI (together defined as "advanced imaging") examinations associated with ED visits in 2015 were identified for continuously enrolled Medicare beneficiaries. Individuals with medical claims 30 days before the index ED event were excluded, and encounters that occurred in hospitals without advanced imaging capabilities were also excluded. Patient characteristics were identified using Medicare files and hospital characteristics using the American Hospital Association Annual Survey of Hospitals. Multivariate logistic regression was used for the analysis. Of 86,976 qualifying ED encounters, 52,833 (60.74%) ED encounters were for female patients; 29.03% ( = 25,245) occurred at rural hospitals and 15.81% ( = 13,750) at critical access hospitals. Race distribution was 83.13% White, 11.05% Black, and 5.82% Other. Compared with ED patients at urban hospitals, those at rural and critical access hospitals were 6.9% less likely (odds ratio [OR] = 0.931, = 0.015) and 18.0% less likely (OR = 0.820, < 0.0001), respectively, to undergo advanced imaging. Compared with White patients, Black patients were 31.6% less likely (OR = 0.684, < 0.0001) to undergo advanced imaging. Relative to their urban counterparts, both White (OR = 0.941, = 0.05) and Black (OR = 0.808, = 0.047) rural ED patients were less likely to undergo advanced imaging. Among Medicare beneficiaries receiving care in U.S. EDs, significant disparities exist in advanced imaging utilization. Although imaging appropriateness was not investigated, these findings suggest inequity. Further research is necessary to understand why consistent health benefits do not translate into consistent imaging access among risk-adjusted ED patients.
我们的研究目的是评估急诊科就诊中高级影像学利用的潜在差异。这项回顾性研究使用了 5%的研究可识别文件。所有 2015 年与急诊科就诊相关的 CT 和 MRI（统称为“高级影像学”）检查都被确定为连续参保的医疗保险受益人。排除了在指数 ED 事件前 30 天有医疗索赔的个体，也排除了在没有高级影像学能力的医院就诊的患者。使用医疗保险文件确定患者特征，使用美国医院协会年度医院调查确定医院特征。采用多变量逻辑回归进行分析。在 86976 例符合条件的急诊科就诊中，52833 例（60.74%）为女性患者；29.03%（=25245）发生在农村医院，15.81%（=13750）发生在关键接入医院。种族分布为 83.13%白人，11.05%黑人，5.82%其他。与城市医院的急诊科患者相比，农村和关键接入医院的患者进行高级影像学检查的可能性分别低 6.9%（优势比[OR] = 0.931， = 0.015）和 18.0%（OR = 0.820，<0.0001）。与白人患者相比，黑人患者进行高级影像学检查的可能性低 31.6%（OR = 0.684，<0.0001）。与城市同龄人相比，白人（OR = 0.941， = 0.05）和黑人（OR = 0.808， = 0.047）农村急诊科患者进行高级影像学检查的可能性较低。在美国急诊科接受治疗的医疗保险受益人中，高级影像学的利用存在显著差异。尽管没有调查影像学的适宜性，但这些发现表明存在不平等。需要进一步研究以了解为什么风险调整后的急诊科患者没有一致的影像学获得一致的健康获益。
