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Narayan AK, Miles RC, Milton A, Salazar G, Spalluto LB, Babagbemi K, Stowell JT, Flores EJ, Dako F, Weissman IA. Fostering Patient-Centered Equitable Care in Radiology: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023; 221:711-719. [PMID: 37255040 DOI: 10.2214/ajr.23.29261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Patient-centered care (PCC) and equity are two of the six core domains of quality health care, according to the Institute of Medicine. Exceptional imaging care requires radiology practices to provide patient-centered (i.e., respectful and responsive to individual patient preferences, needs, and values) and equitable (i.e., does not vary in quality on the basis of gender, ethnicity, geographic location, or socioeconomic status) care. Specific barriers that prevent the delivery of patient-centered equitable care include information gaps, breaches of trust, organizational medical culture, and financial incentives. Information gaps limit practitioners in understanding the lived experience of patients. Breaches of trust prevent patients from seeking needed medical care. Organizational medical cultures may not be centered around patient experiences. Financial incentives can impede practitioners' ability to spend the time and resources required to meet patient goals and needs. Intentional approaches that integrate core principles in both PCC and health equity are required to deliver high-quality patient-centered imaging care for diverse patient populations. The purpose of this AJR Expert Panel Narrative Review is to review the origins of the PCC movement in radiology, characterize connections between the PCC and health equity movements, and describe concrete examples of ways to foster patient-centered equitable care in radiology.
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Affiliation(s)
- Anand K Narayan
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, F6/178C, Madison, WI 53792-3252
| | | | - Arissa Milton
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, F6/178C, Madison, WI 53792-3252
| | - Gloria Salazar
- Department of Radiology, University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Lucy B Spalluto
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN
- Department of Radiology, Vanderbilt-Ingram Cancer Center, Nashville, TN
- Department of Radiology, Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center, Nashville, TN
| | - Kemi Babagbemi
- Department of Radiology, Weill Cornell Medicine, New York, NY
| | | | - Efren J Flores
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Farouk Dako
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Ian A Weissman
- Department of Radiology, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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Treister-Goltzman Y, Peleg R, Sagy I, Menashe I. Health services utilization by fibromyalgia patients from two ethnic groups. Int J Rheum Dis 2023; 26:1923-1931. [PMID: 37443460 DOI: 10.1111/1756-185x.14836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 06/11/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023]
Abstract
AIM The cost to the healthcare system of management and treatment for fibromyalgia patients is high. The aims of the study were to identify and compare factors associated with the use of healthcare services among fibromyalgia patients in southern Israel from two ethnic groups. METHODS A cross-sectional study of patients insured in the southern district of the Clalit Healthcare Services in Israel in 2019-2020. The data were collected from the central computerized system. Multivariable regression models were developed for healthcare services utilization. RESULTS During the study period, 7686 members were diagnosed with fibromyalgia. The median for specialist consultations was 47 and for imaging tests was eight. About 47% made emergency room visits and 25% were hospitalized. The median of imaging tests was significantly higher in Jewish patients than in Arab patients (8 vs. 6; p = .000). In contrast, a significantly higher rate of Arab patients visited the Emergency Room at least once (51.6% vs. 46.75%; p = .000) and they had a higher median number or Emergency Room visits (2 vs. 1; p = .003), compared with Jewish patients. In the Arab group there was a strong effect coefficient for another localized pain syndrome with specialist consultations (odds ratio [OR] 1.699; 95% confidence interval [CI] 1.266-2.241) and imaging tests (OR 2.511; 95% CI 1.496-4.146). CONCLUSIONS The utilization rate of healthcare services is high among fibromyalgia patients. The factors associated with high healthcare utilization are different in the two ethnic groups. Future studies could show if interventions designed to address modifiable factors could reduce the overutilization of healthcare services.
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Affiliation(s)
- Yulia Treister-Goltzman
- The Department of Family Medicine, Siaal Research Center for Family Practice and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Clalit Health Services, Tel Aviv, Israel
| | - Roni Peleg
- The Department of Family Medicine, Siaal Research Center for Family Practice and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Clalit Health Services, Tel Aviv, Israel
| | - Iftach Sagy
- Rheumatology Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
- Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Idan Menashe
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Gichoya JW, Thomas K, Celi LA, Safdar N, Banerjee I, Banja JD, Seyyed-Kalantari L, Trivedi H, Purkayastha S. AI pitfalls and what not to do: mitigating bias in AI. Br J Radiol 2023; 96:20230023. [PMID: 37698583 PMCID: PMC10546443 DOI: 10.1259/bjr.20230023] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/13/2023] Open
Abstract
Various forms of artificial intelligence (AI) applications are being deployed and used in many healthcare systems. As the use of these applications increases, we are learning the failures of these models and how they can perpetuate bias. With these new lessons, we need to prioritize bias evaluation and mitigation for radiology applications; all the while not ignoring the impact of changes in the larger enterprise AI deployment which may have downstream impact on performance of AI models. In this paper, we provide an updated review of known pitfalls causing AI bias and discuss strategies for mitigating these biases within the context of AI deployment in the larger healthcare enterprise. We describe these pitfalls by framing them in the larger AI lifecycle from problem definition, data set selection and curation, model training and deployment emphasizing that bias exists across a spectrum and is a sequela of a combination of both human and machine factors.
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Affiliation(s)
| | - Kaesha Thomas
- Department of Radiology, Emory University, Atlanta, United States
| | | | - Nabile Safdar
- Department of Radiology, Emory University, Atlanta, United States
| | - Imon Banerjee
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, United States
| | - John D Banja
- Emory University Center for Ethics, Emory University, Atlanta, United States
| | - Laleh Seyyed-Kalantari
- Department of Electrical Engineering and Computer Science, Lassonde School of Engineering, York University, North York, United States
| | - Hari Trivedi
- Department of Radiology, Emory University, Atlanta, United States
| | - Saptarshi Purkayastha
- School of Informatics and Computing, Indiana University Purdue University, Indianapolis, United States
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Slanetz PJ, Almeky S, Narayan AK, Bello JA. Pursuing Imaging Equity-Overcoming Barriers, Finding Opportunities. J Am Coll Radiol 2023; 20:1075-1077. [PMID: 37619799 DOI: 10.1016/j.jacr.2023.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/06/2023] [Accepted: 06/14/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Priscilla J Slanetz
- Vice Chair of Academic Affairs, Department of Radiology, and Associate Program Director of the Diagnostic Radiology Residency, Department of Radiology, Boston University Medical Center, Boston, Massachusetts, and is also from the Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts; Director of Early Career Faculty Development and Academic Writing Programs for Boston University Medical Group; Past President of Massachusetts Radiological Society; President of the Association of University Radiologists; and Subspecialty Chair of the ACR Appropriateness Criteria Breast Imaging Panels.
| | - Somiah Almeky
- Department of Radiology, Boston University Medical Center, Boston, Massachusetts, and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts; Vice President of the Massachusetts Radiological Society; Resident, Fellow Section; President-Elect for the next academic year; Radiology Advocacy Network Leader; member Medical Student and Resident teaching committee; and Diversity Equity and Inclusion Council Fellow at Boston Medical Center
| | - Anand K Narayan
- Vice Chair of Equity, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Associate Director of the University of Wisconsin Carbone Cancer Center for Diversity, Equity, and Inclusion; Vice Chair of the ACR's Patient- and Family-Centered Care Outreach Committee; and Director at Large of the Wisconsin Radiological Society
| | - Jacqueline A Bello
- Director of Neuroradiology, Department of Radiology, Montefiore Medical Center, Bronx, New York; Zimmer-Hardy Professor of Neuroradiology, Department of Radiology, Albert Einstein College of Medicine; Chair, ACR Board of Chancellors; and a Past President of the New York Radiological Society, the New York Roentgen Society, and the American Society of Neuroradiology
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Chen Q, Vella SP, Maher CG, Ferreira GE, Machado GC. Racial and ethnic differences in the use of lumbar imaging, opioid analgesics and spinal surgery for low back pain: A systematic review and meta-analysis. Eur J Pain 2023; 27:476-491. [PMID: 36585947 DOI: 10.1002/ejp.2075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 12/06/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVE There is a substantial gap between evidence and clinical care for low back pain (LBP) worldwide despite recommendations of best practice specified in clinical practice guidelines. The aim of this systematic review was to identify disparities associated with race or ethnicity in the use of lumbar imaging, opioid analgesics, and spinal surgery in people with LBP. DATABASES AND DATA TREATMENT We included observational studies which compared the use of lumbar imaging, opioid analgesics, and spinal surgery for the management of non-serious LBP between people from different racial/ethnic populations. We searched in MEDLINE, EMBASE and CINAHL from January 2000 to June 2021. Risk of bias of included studies was appraised in six domains. For each type of care, we pooled data stratified by race and ethnicity using random effects models. RESULTS We identified 13 eligible studies; all conducted in the United States. Hispanic/Latino (OR 0.69, 95%CI 0.49-0.96) and Black/African American (OR 0.59, 95%CI 0.46-0.75) people with LBP were less likely to be prescribed opioid analgesics than White people. Black/African Americans were less likely to undergo or be recommended spinal surgery for LBP (OR 0.47, 95%CI 0.33-0.67) than White people. There was a lack of high certainty evidence on racial/ethnic disparities in the use of lumbar imaging. CONCLUSION This review reveals lower rate of the use of guideline-discordant care, especially opioid prescription and spinal surgery, in racial/ethnic minority populations with LBP in the United States. Future studies in other countries evaluating care equity for LBP are warranted. PROSPERO Registration ID: CRD42021260668. SIGNIFICANCE This systematic review and meta-analysis revealed that people with low back pain from the minority racial/ethnic backgrounds were less likely to be prescribed opioid analgesics and undergo spinal surgery than the majority counterparts. Strategic interventions to improve the access to, and the value of, clinical care for minority populations with low back pain are warranted.
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Affiliation(s)
- Qiuzhe Chen
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Simon P Vella
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Chris G Maher
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Giovanni E Ferreira
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Gustavo C Machado
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
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Rammohan R, Joy MV, Saggar T, Magam SG, Sinha A, Natt D, Gomez S, Sheikh S, Anand P, Mustacchia P. Healthcare Disparities and Upper Gastrointestinal Bleeding: Exploring the Linkages. Cureus 2023; 15:e37977. [PMID: 37101799 PMCID: PMC10123219 DOI: 10.7759/cureus.37977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2023] [Indexed: 04/28/2023] Open
Abstract
Introduction Upper gastrointestinal bleeding (UGIB) refers to blood loss from a gastrointestinal (GI) source proximal or above the ligament of Treitz. Health equity means giving everyone an equal chance to achieve optimal health by addressing injustices, overcoming barriers, and eliminating health disparities. Healthcare providers must analyze racial and ethnic disparities in UGIB management to ensure all patients receive equal care. Identifying risk factors in specific populations leads to tailored interventions that improve outcomes. Our study aims to examine trends and identify disparities in upper gastrointestinal bleeding across races and ethnicities to promote health equity. Methods Retrospective data on upper gastrointestinal bleeding from June 2009 to June 2022 were collected and categorized into five groups based on race. The baseline characteristics of each group were matched to ensure equitable comparison. A joinpoint regression model was used to compare incidence trends, identifying potential healthcare disparities for different racial/ethnic groups over time. Patients aged 18-75 who suffered from upper gastrointestinal bleeding at Nassau University Medical Center in New York from 2010 to 2021 were selected, excluding those with incomplete baseline comorbidity information. Results This study examined 5103 cases of upper gastrointestinal bleeding, with 41.9% female. The cohort was diverse, with 29.4% African American, 15.6% Hispanic, 45.3% White, 6.8% Asian, and 2.9% of other races. Data were split into two groups; 49.9% occurred between 2009 and 2015 and 50.1% between 2016 and 2022. Findings showed increased UGIB among Hispanics and decreased bleeding among Asians during 2016-2021 compared to 2009-2015. However, no significant difference was found for African Americans, Whites, and other races. In addition, Hispanics had a rise in the annual percentage change (APC) rate, whereas Asians had a decrease. Conclusion Our study examined trends in upper gastrointestinal bleeding and potential healthcare disparities across races and ethnicities. Our findings highlight an increased incidence of UGIB in Hispanics and a decreased incidence in Asians. Additionally, we identified a significant increase in the annual percentage change rate in Hispanics and a decrease in Asians over time. Our study underscores the importance of identifying and addressing disparities in UGIB management to promote health equity. Future research can build on these findings to develop tailored interventions that improve patient outcomes.
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Affiliation(s)
- Rajmohan Rammohan
- Gastroenterology, Nassau University Medical Center, East Meadow, USA
| | - Melvin V Joy
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | - Tulika Saggar
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | | | - Atul Sinha
- Gastroenterology and Hepatology, Nassau University Medical Center, East Meadow, USA
| | - Dilman Natt
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | - Sandra Gomez
- Gastroenterology and Hepatology, Nassau University Medical Center, East Meadow, USA
| | - Saher Sheikh
- Gastroenterology and Hepatology, Nassau University Medical Center, East Meadow, USA
| | - Prachi Anand
- Rheumatology, Nassau University Medical Center, East Meadow, USA
| | - Paul Mustacchia
- Gastroenterology and Hepatology, Nassau University Medical Center, East Meadow, USA
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Bucknor MD, Narayan AK, Spalluto LB. A Framework for Developing Health Equity Initiatives in Radiology. J Am Coll Radiol 2023; 20:385-392. [PMID: 36922114 DOI: 10.1016/j.jacr.2022.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 03/16/2023]
Abstract
PURPOSE In recent years, radiology departments have increasingly recognized the extent of health care disparities related to imaging and image-guided interventions. The goal of this article is to provide a framework for developing a health equity initiative in radiology and to articulate key defining factors. METHODS This article leverages the experience of three academic radiology departments and explores key principles that emerged when observing the experiences of these departments that have begun to engage in health equity-focused work. RESULTS A four-component framework is described for a health equity initiative in radiology consisting of (1) environmental scan and blueprint, (2) design and implementation, (3) initiative evaluation, and (4) community engagement. Key facilitators include a comprehensive environmental scan, early stakeholder engagement and consensus building, implementation science design thinking, and multitiered community engagement. CONCLUSIONS All radiology organizations should strive to develop, pilot, and evaluate novel initiatives that promote equitable access to high-quality imaging services. Establishing systems for high-quality data collection is critical to success. An implementation science approach provides a robust framework for developing and testing novel health equity initiatives in radiology. Community engagement is critical at all stages of the health equity initiative time line.
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Affiliation(s)
- Matthew D Bucknor
- Associate Chair for Wellbeing and Professional Climate, Department of Radiology and Biomedical Imaging and Executive Sponsor, Differences Matter, University of California, San Francisco, California.
| | - Anand K Narayan
- Vice Chair of Health Equity, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. https://twitter.com/%20AnandKNarayan
| | - Lucy B Spalluto
- Chair of Health Equity, Department of Radiology, Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center, Nashville, Tennessee. https://twitter.com/%20LBSrad
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Aquino YSJ, Carter SM, Houssami N, Braunack-Mayer A, Win KT, Degeling C, Wang L, Rogers WA. Practical, epistemic and normative implications of algorithmic bias in healthcare artificial intelligence: a qualitative study of multidisciplinary expert perspectives. JOURNAL OF MEDICAL ETHICS 2023:jme-2022-108850. [PMID: 36823101 DOI: 10.1136/jme-2022-108850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND There is a growing concern about artificial intelligence (AI) applications in healthcare that can disadvantage already under-represented and marginalised groups (eg, based on gender or race). OBJECTIVES Our objectives are to canvas the range of strategies stakeholders endorse in attempting to mitigate algorithmic bias, and to consider the ethical question of responsibility for algorithmic bias. METHODOLOGY The study involves in-depth, semistructured interviews with healthcare workers, screening programme managers, consumer health representatives, regulators, data scientists and developers. RESULTS Findings reveal considerable divergent views on three key issues. First, views on whether bias is a problem in healthcare AI varied, with most participants agreeing bias is a problem (which we call the bias-critical view), a small number believing the opposite (the bias-denial view), and some arguing that the benefits of AI outweigh any harms or wrongs arising from the bias problem (the bias-apologist view). Second, there was a disagreement on the strategies to mitigate bias, and who is responsible for such strategies. Finally, there were divergent views on whether to include or exclude sociocultural identifiers (eg, race, ethnicity or gender-diverse identities) in the development of AI as a way to mitigate bias. CONCLUSION/SIGNIFICANCE Based on the views of participants, we set out responses that stakeholders might pursue, including greater interdisciplinary collaboration, tailored stakeholder engagement activities, empirical studies to understand algorithmic bias and strategies to modify dominant approaches in AI development such as the use of participatory methods, and increased diversity and inclusion in research teams and research participant recruitment and selection.
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Affiliation(s)
- Yves Saint James Aquino
- Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Stacy M Carter
- Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Nehmat Houssami
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- The Daffodil Centre, Sydney, New South Wales, Australia
| | - Annette Braunack-Mayer
- Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Khin Than Win
- Centre for Persuasive Technology and Society, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Chris Degeling
- Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Lei Wang
- Centre for Artificial Intelligence, School of Computing and Information Technology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Wendy A Rogers
- Department of Philosophy and School of Medicine, Macquarie University, Sydney, New South Wales, Australia
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Goldberg JE, Prabhu V, Smereka PN, Hindman NM. How We Got Here: The Legacy of Anti-Black Discrimination in Radiology. Radiographics 2023; 43:e220112. [PMID: 36633971 DOI: 10.1148/rg.220112] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Current disparities in the access to diagnostic imaging for Black patients and the underrepresentation of Black physicians in radiology, relative to their representation in the general U.S. population, reflect contemporary consequences of historical anti-Black discrimination. These disparities have existed within the field of radiology and professional medical organizations since their inception. Explicit and implicit racism against Black patients and physicians was institutional policy in the early 20th century when radiology was being developed as a clinical medical field. Early radiology organizations also embraced this structural discrimination, creating strong barriers to professional Black radiologist involvement. Nevertheless, there were numerous pioneering Black radiologists who advanced scholarship, patient care, and diversity within medicine and radiology during the early 20th century. This work remains important in the present day, as race-based health care disparities persist and continue to decrease the quality of radiology-delivered patient care. There are also structural barriers within radiology affecting workforce diversity that negatively impact marginalized groups. Multiple opportunities exist today for antiracism work to improve quality of care and to apply standards of social justice and health equity to the field of radiology. An initial step is to expand education on the disparities in access to imaging and health care among Black patients. Institutional interventions include implementing community-based outreach and applying antibias methodology in artificial intelligence algorithms, while systemic interventions include identifying national race-based quality measures and ensuring imaging guidelines properly address the unique cancer risks in the Black patient population. These approaches reflect some of the strategies that may mutually serve to address health care disparities in radiology. © RSNA, 2023 See the invited commentary by Scott in this issue. Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Julia E Goldberg
- From the Department of Radiology, NYU Langone Health, 550 1st Ave, New York, NY 10016
| | - Vinay Prabhu
- From the Department of Radiology, NYU Langone Health, 550 1st Ave, New York, NY 10016
| | - Paul N Smereka
- From the Department of Radiology, NYU Langone Health, 550 1st Ave, New York, NY 10016
| | - Nicole M Hindman
- From the Department of Radiology, NYU Langone Health, 550 1st Ave, New York, NY 10016
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Christensen EW, Waid M, Scott J, Patel BK, Bello JA, Rula EY. Relationship between Race and Access to Newer Mammographic Technology in Women with Medicare Insurance. Radiology 2023; 306:e221153. [PMID: 36219114 DOI: 10.1148/radiol.221153] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Racial disparities in breast cancer mortality have been reported. Mammographic technology has undergone two major technology transitions since 2000: first, the transition from screen-film mammography (SFM) to full-field digital mammography (FFDM) and second, the transition to digital breast tomosynthesis (DBT). Purpose To examine the relationship between use of newer mammographic technology and race in women receiving mammography services. Materials and Methods This was a multiyear (January 2005 to December 2020) retrospective study of women aged 40-89 years with Medicare fee-for-service insurance who underwent mammography. Data were obtained using a 5% research identifiable sample of all Medicare fee-for-service beneficiaries. Within-institution and comparable-institution use of mammographic technology between Black women or women of other races and White women were assessed with multivariable logistic and linear regression, respectively, adjusted for age, race, Charlson comorbidity index, per capita income, urbanicity, and institutional capability. Results Between 2005 and 2020, there were 4 028 696 institutional mammography claims for women (mean age, 72 years ± 8 [SD]). Within an institution, the odds ratio (OR) of Black women receiving digital mammography rather than SFM in 2005 was 0.80 (95% CI: 0.70, 0.91; P < .001) when compared with White women; these differences remained until 2009. Compared with White women, the use of DBT within an institution was less likely for Black women from 2015 to 2020 (OR, 0.84; 95% CI: 0.81, 0.87; P < .001). Across institutions, there were racial differences in digital mammography use, which followed a U-shaped pattern, and the differences peaked at 3.8 percentage points less for Black compared with White women (95% CI: -6.1, -1.6; P = .001) in 2011 and then decreased to 1.2 percentage points less (95% CI: -2.2, -0.2; P = .02) in 2016. Conclusion In the Medicare population, Black women had less access to new mammographic imaging technology compared with White women for both the transition from screen-film mammography to digital mammography and then for the transition to digital breast tomosynthesis. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Lee and Lawson in this issue.
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Affiliation(s)
- Eric W Christensen
- From the Neiman Health Policy Institute, 1891 Preston White Dr, Reston, VA 20191 (E.W.C., M.W., E.Y.R.); Health Services Management, University of Minnesota, St Paul, Minn (E.W.C.); Department of Radiology, SUNY Downstate Health Sciences University, Brooklyn, NY (J.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (B.K.P.); and Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY (J.A.B.)
| | - Mikki Waid
- From the Neiman Health Policy Institute, 1891 Preston White Dr, Reston, VA 20191 (E.W.C., M.W., E.Y.R.); Health Services Management, University of Minnesota, St Paul, Minn (E.W.C.); Department of Radiology, SUNY Downstate Health Sciences University, Brooklyn, NY (J.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (B.K.P.); and Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY (J.A.B.)
| | - Jinel Scott
- From the Neiman Health Policy Institute, 1891 Preston White Dr, Reston, VA 20191 (E.W.C., M.W., E.Y.R.); Health Services Management, University of Minnesota, St Paul, Minn (E.W.C.); Department of Radiology, SUNY Downstate Health Sciences University, Brooklyn, NY (J.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (B.K.P.); and Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY (J.A.B.)
| | - Bhavika K Patel
- From the Neiman Health Policy Institute, 1891 Preston White Dr, Reston, VA 20191 (E.W.C., M.W., E.Y.R.); Health Services Management, University of Minnesota, St Paul, Minn (E.W.C.); Department of Radiology, SUNY Downstate Health Sciences University, Brooklyn, NY (J.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (B.K.P.); and Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY (J.A.B.)
| | - Jacqueline A Bello
- From the Neiman Health Policy Institute, 1891 Preston White Dr, Reston, VA 20191 (E.W.C., M.W., E.Y.R.); Health Services Management, University of Minnesota, St Paul, Minn (E.W.C.); Department of Radiology, SUNY Downstate Health Sciences University, Brooklyn, NY (J.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (B.K.P.); and Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY (J.A.B.)
| | - Elizabeth Y Rula
- From the Neiman Health Policy Institute, 1891 Preston White Dr, Reston, VA 20191 (E.W.C., M.W., E.Y.R.); Health Services Management, University of Minnesota, St Paul, Minn (E.W.C.); Department of Radiology, SUNY Downstate Health Sciences University, Brooklyn, NY (J.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (B.K.P.); and Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY (J.A.B.)
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Practical Approaches to Advancing Health Equity in Radiology, From the AJR Special Series on DEI. AJR Am J Roentgenol 2023:1-10. [PMID: 36629307 DOI: 10.2214/ajr.22.28783] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Despite significant advances in healthcare, many patients from medically underserved populations are impacted by existing healthcare disparities. Radiologists are uniquely positioned to decrease health disparities and advance health equity efforts in their practices. However, literature on practical tools for advancing radiology health equity efforts applicable to a wide variety of patient populations and care settings is lacking. Therefore, this article seeks to equip radiologists with an evidence-based and practical knowledge toolkit of health equity strategies, presented in terms of four pillars of research, clinical care, education, and innovation. For each pillar, equity efforts across diverse patient populations and radiology practice settings are examined through the lens of existing barriers, current best practices, and future directions, incorporating practical examples relevant to a spectrum of patient populations. Health equity efforts provide an opportune window to transform radiology through personalized care delivery that is responsive to diverse patient needs. Guided by compassion and empathy as core principles of health equity, leveraging the four pillars provides a helpful framework to advance health equity efforts as a step towards social justice in health.
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Timpone VM, Reid M, Jensen A, Poisson SN, Patten L, Costa B, Trivedi PS. Lost to Follow-Up: A Nationwide Analysis of Patients With Transient Ischemic Attack Discharged From Emergency Departments With Incomplete Imaging. J Am Coll Radiol 2022; 19:957-966. [PMID: 35724735 DOI: 10.1016/j.jacr.2022.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Imaging guidelines for transient ischemic attack (TIA) recommend that patients undergo urgent brain and neurovascular imaging within 48 hours of symptom onset. Prior research suggests that most patients with TIA discharged from the emergency department (ED) do not complete recommended TIA imaging workup during their ED encounters. The purpose of this study was to determine the nationwide percentage of patients with TIA discharged from EDs with incomplete imaging workup who complete recommended imaging after discharge. METHODS Patients discharged from EDs with the diagnosis of TIA were identified from the Medicare 5% sample for 2017 and 2018 using International Classification of Diseases, tenth rev, Clinical Modification codes. Imaging performed was identified using Current Procedural Terminology codes. Incomplete imaging workup was defined as a TIA encounter without cross-sectional brain, brain-vascular, and neck-vascular imaging performed within the subsequent 30 days of the initial ED encounter. Patient- and hospital-level factors associated with incomplete TIA imaging were analyzed in a multivariable logistic regression. RESULTS In total, 6,346 consecutive TIA encounters were analyzed; 3,804 patients (59.9%) had complete TIA imaging workup during their ED encounters. Of the 2,542 patients discharged from EDs with incomplete imaging, 761 (29.9%) completed imaging during the subsequent 30 days after ED discharge. Among patients with TIA imaging workup completed after ED discharge, the median time to completion was 5 days. For patients discharged from EDs with incomplete imaging, the odds of incomplete TIA imaging at 30 days after discharge were highest for black (odds ratio, 1.84; 95% confidence interval, 1.27-2.66) and older (≥85 years of age; odds ratio, 2.41; 95% confidence interval, 1.78-3.26) patients. Reference values were age cohort 65 to 69 years; male gender; white race; no co-occurring diagnoses of hypertension, hyperlipidemia, or diabetes mellitus; household income > $63,029; hospital in the Northeast region; urban hospital location; hospital size > 400 beds; academically affiliated hospital; and facility with access to MRI. CONCLUSIONS Most patients discharged from EDs with incomplete TIA imaging workup do not complete recommended imaging within 30 days after discharge.
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Affiliation(s)
- Vincent M Timpone
- Director, Stroke and Vascular Imaging and Co-Director, Neuroradiology, Spine Intervention Service, Department of Radiology, University of Colorado Hospital, Aurora, Colorado.
| | - Margaret Reid
- Department of Health Systems, Management & Policy, Colorado School of Public Health, Aurora, Colorado
| | - Alexandria Jensen
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Sharon N Poisson
- Director, Vascular and Stroke Research Fellowship, Department of Neurology, University of Colorado Hospital, Aurora, Colorado
| | - Luke Patten
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Bernardo Costa
- Department of Radiology, University of Colorado Hospital, Aurora, Colorado
| | - Premal S Trivedi
- Director, Health Services Research, Department of Radiology, University of Colorado Hospital, Aurora, Colorado
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