Exacerbation of Inequities in Use of Diagnostic Radiology During the Early Stages of Reopening After COVID-19.
Exacerbation of Inequities in Use of Diagnostic Radiology During the Early Stages of Reopening After COVID-19.
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DOI：
10.1016/j.jacr.2020.12.009
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发表时间：
2021-05
期刊：
影响因子：
--
通讯作者：
Khorasani R
中科院分区：
文献类型：
--
作者：
Lacson R;Shi J;Kapoor N;Eappen S;Boland GW;Khorasani R
评估在因2019冠状病毒病（COVID-19）而导致国家强制关闭非紧急服务后重新开放的早期阶段，诊断放射学检查的利用率和相关的社会健康决定因素。这项机构审查委员会批准的回顾性研究评估了在COVID-19关闭之前（2020年1月1日至2020年3月8日）和之后（2020年6月7日至2020年7月15日）在一家拥有8个附属门诊设施的学术医疗中心进行诊断放射学检查的所有患者。关闭期间（2020年3月9日至2020年6月6日）的考试被排除在外。从研究数据仓库中提取患者特异性因素（例如，人种、种族）、成像方式和护理环境。主要结果是COVID-19关闭前后每天诊断放射学检查的数量。单变量分析和多变量逻辑回归确定与完成检查相关的特征。尽管恢复了非紧急服务，但在COVID-19关闭后，所有护理机构的放射检查使用率仍显着下降（停机前每天869次检查[68天内59，080次检查]，停机后每天502次检查[39天内19，594次检查]），与急诊科相比，在住院和门诊进行检查的优势比更显著降低。不平等现象进一步恶化，来自贫困率、失业率和慢性病率高的社区的患者在COVID-19关闭后接受放射学检查的几率显著降低。与白色和非西班牙裔患者相比，亚裔和西班牙裔患者在COVID-19关闭后进行检查的比值比分别显著较低。2019冠状病毒病大流行加剧了诊断放射学利用方面已知的不公平现象。应分配资源，以解决可能不太可能接受必要的诊断放射学检查的患者亚组，可能导致患者安全和护理质量受损。
Assess diagnostic radiology examination utilization and associated social determinants of health during the early stages of reopening after state-mandated shutdown of nonurgent services because of coronavirus disease 2019 (COVID-19). This institutional review board–approved, retrospective study assessed all patients with diagnostic radiology examinations performed at an academic medical center with eight affiliated outpatient facilities before (January 1, 2020, to March 8, 2020) and after (June 7, 2020, to July 15, 2020) the COVID-19 shutdown. Examinations during the shut down (March 9, 2020, to June 6, 2020) were excluded. Patient-specific factors (eg, race, ethnicity), imaging modalities, and care settings were extracted from the Research Data Warehouse. Primary outcome was the number of diagnostic radiology examinations per day compared pre- and post-COVID-19 shutdown. Univariate analysis and multivariable logistic regression determined features associated with completing an examination. Despite resumption of nonurgent services, marked decrease in radiology examination utilization persisted in all care settings post-COVID-19 shutdown (869 examinations per day preshutdown [59,080 examinations in 68 days] versus 502 examinations per day postshutdown [19,594 examinations in 39 days]), with more significantly decreased odds ratios for having examinations in inpatient and outpatient settings versus in the emergency department. Inequities worsened, with patients from communities with high rates of poverty, unemployment, and chronic disease having significantly lower odds of undergoing radiology examinations post-COVID-19 shutdown. Patients of Asian race and Hispanic ethnicity had significantly lower odds ratios for having examinations post-COVID-19 shutdown compared with White and non-Hispanic patients, respectively. The COVID-19 pandemic has exacerbated known pre-existing inequities in diagnostic radiology utilization. Resources should be allocated to address subgroups of patients who may be less likely to receive necessary diagnostic radiology examinations, potentially leading to compromised patient safety and quality of care.
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