Patient Sociodemographic Characteristics Associated With Saturday Breast Imaging Clinic Utilization

Breast Imaging Patient Demographics at a Major Comprehensive Cancer Center Before and During the COVID-19 Pandemic

OBJECTIVE

The coronavirus disease of 2019 (COVID-19) pandemic disproportionately affected certain vulnerable communities. The purpose of our study was to determine how COVID-19 affected the socioeconomic demographics of breast imaging patients at a major comprehensive cancer center.

METHODS

This retrospective cohort study compared female patients who underwent screening mammograms, diagnostic mammograms, breast ultrasound, or breast MRI during the following time periods: prepandemic (February 1, 2018, through February 29, 2020), acute pandemic (March 1, 2020, through June 30, 2020), subacute pandemic (August 1, 2020, through December 31, 2020), and chronic pandemic (January 1, 2021, through June 30, 2022). Statistics were performed using the generalized estimating equations approach.

RESULTS

A total of 74,398 female patients (mean age, 55.6 ± 12.4 years) underwent 238,776 total breast imaging examinations. For screening mammograms, Hispanics represented 27.1% (9,197 of 33,960) of patients in the prepandemic time period compared with 16.7% (604 of 3,621) in the acute pandemic time period, 18.7% (1,835 of 9,830) in the subacute pandemic time period, and 24.3% (7,492 of 30,869) in the chronic pandemic time period (all P < .0001). Self-pay patients saw similar declines for screening mammograms during the same time periods: 21.7% (7,375 of 33,960), 7.9% (286 of 3,621), 9.5% (933 of 9,830), and 17.4% (5,357 of 30,869), respectively (all P < .0001, compared with the prepandemic time period). Similarly dramatic trends were not observed for race or other imaging examinations.

DISCUSSION

At our cancer center, Hispanics and self-pay patients were disproportionately affected by the COVID-19 pandemic. Strategies to improve health inequities are needed.

Fostering Patient-Centered Equitable Care in Radiology: AJR Expert Panel Narrative Review

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.

A Framework for Developing Health Equity Initiatives in Radiology

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.