Insurance type influences adherence to follow-up imaging

By Amerigo Allegretto, staff writer

July 26, 2022 -- Patients with Medicaid have four times lower odds of completing follow-up imaging compared with patients with commercial insurance, a study published July 25 in Clinical Imaging found.

A team led by Dr. Andrés ángel-González Calvillo from the University of California, San Francisco also found that other patient demographic factors such as age, gender, race and ethnicity, and socioeconomic status don't necessarily factor into whether they complete follow-up imaging.

"Radiology departments should work to develop more equitable workflows in follow-up imaging that meet the needs of all patients," Calvillo and colleagues wrote.

The researchers have found disparities in imaging access in previous studies, which is problematic since follow-up imaging is needed to answer clinical questions for many patients. Adherence rates may lead to further disparities in clinical imaging, even with updated communication systems for hospitals.

Delayed imaging use and action on findings can lead to longer hospital stays, increased morbidity and mortality, and higher costs.

So far, it has been challenging to pinpoint what exactly influences whether a patient completes a follow-up study. Therefore, Calvillo et al wanted to find out which patient factors were linked to differences in completing follow-up imaging recommendations.

The team looked at 350 reports that included recommendations for additional imaging from 2017. Out of these, 308 (88%) had corresponding follow-up imaging present. The insurance payor was known for 266 (86.36%) patients, including 146 (47.40%) having commercial insurance, 35 (11.36%) having Medicaid, and 85 (27.60%) having Medicare.

The study authors found that patients with Medicaid were least likely to complete follow-up recommendations, while those with commercial insurance were most likely.

Influence of insurance type on follow-up imaging adherence
  Commercial insurance Medicare Medicaid
Number of patients who completed imaging 146 85 35
Odds ratio 1 0.63 0.24
p-value 1 0.38 0.03

The researchers also found that the following patient-level factors were not independently tied to differences in follow-up imaging completion: age, gender, race and ethnicity, smoking history, primary language, body mass index, and neighborhood socioeconomic status.

They also found no significant differences in odds for completing follow-up when the recommended imaging study was a radiograph compared to ultrasound, CT, PET, MRI, and nuclear medicine. There were also no odds differences comparing follow-up completion for patients who received their initial imaging as inpatients compared with outpatients or emergency room patients.

The study authors noted that several studies have linked potential disparities in follow-up to patients on government-issued insurance overusing emergency services as primary care. They also suggested that physicians either being unaware or ignoring the American College of Radiology (ACR) Appropriateness Criteria contribute to this.

"The findings of these studies and ours demonstrate the complex interplay of factors that affect patients' utilization of advanced imaging follow-up, influenced by both provider and patient-level factors," the authors wrote.

The team also suggested that expanded education and training for healthcare residents who work in care coordination for patients could help foster improved equity in imaging use.

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