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Access to Advanced Medical Imaging Procedures in Rural and Critical Access Hospitals
Access to Advanced Medical Imaging Procedures in Rural and Critical Access Hospitals
Tuesday, June 25, 2019
Exhibit Hall C (Marriott Wardman Park Hotel)
Emergency department (ED) imaging has grown dramatically over the past decade – particularly for advanced imaging procedures such as computed tomography and magnetic resonance imaging. Despite this rapid growth, there are concerns over access to these procedures in rural and critical access hospitals. Employing patient level data from a 5% national sample of Medicare beneficiaries in 2016, we identify a cohort of emergency department patients with no medical claims 30 days prior to the ED visit in rural hospitals, critical access hospitals, and urban hospitals. We then use multivariate logistic regression with propensity score matching to examine the likelihood of an ED patient receiving an advanced imaging procedure in rural and critical access hospitals that offer these services relative to urban hospitals, controlling for patient demographics, patients’ prospective risk, and hospital characteristics. We find that patients visiting EDs in rural hospitals are 6.1% (p<0.01) less likely to receive an advanced imaging procedure relative to urban hospitals and patients in critical access hospitals were 13.3% (p<0.01) less likely to receive these procedures. We also find black ED patients are 31.4% (p<0.001) less likely to receive advanced imaging procedures than white ED patients raising broader concerns of health equity.