Availability of imaging services scarce at critical access hospitals

There is an overall scarcity of access to imaging services at critical access hospitals (CAH) throughout the U.S., according to a study published online April 26 by the Journal of the American College of Radiology.

As of June 2013, there were 1,332 CAHs designated by the Medicare Rural Hospital Flexibility Program in the U.S. Although imaging is a vital piece of services regularly needed for rural and remote populations, it is still a challenge to obtain access to advanced imaging at CAHs. “The fact that rural populations are almost entirely dependent on CAHs for their health care needs makes it necessary to understand the overall distribution and availability of CAHs across the country,” wrote the study’s lead author, Amir A. Khaliq, PhD, of the University of Oklahoma Health Sciences Center in Oklahoma City, and colleagues.

The researchers performed their study to better understand the access and scope of imaging services at CAHs. They also compared characteristics and imaging services provided by standalone CAHs and multi-organization systems or networks.

Using data from the recent American Hospital Association (AHA) annual survey and U.S. census, Khaliq and colleagues collected information regarding mammography, ultrasound, CT, MRI, SPECT and combined PET/CT. The study group included the availability and characteristics of imaging services at 1,060 CAHs in 45 states.

Khaliq et al discovered that mammography, ultrasound and some forms of CT were the most widely available of all of the imaging services. Mammography was available in all CAHs in 13 percent of the states, while ultrasound and CT were available in 33 percent and 56 percent, respectively. However, in no states were 64-slice or greater CT, MRI, SPECT and combined PET/CT available in all CAHs.

If services are not available directly at a CAH, they are often offered by another member of the system or network or through an external arrangement with another community facility. When network or external arrangements were included in the assessment of access, the availability of MRI exhibited the largest increase with 42 states offering this service in at least half of the CAHs. This was a statistically significant increase in state-level access in comparison to the analysis in which only onsite availability of MRI was investigated.

A significantly greater number of states offered MRI services in all communities served by CAHs when external or network service arrangements were included in the assessment. Ultrasound access also significantly increased as 56 percent of states offered ultrasound in CAH-served communities through a network or external arrangement. Conversely, access was possible in 33 percent of states that offered ultrasounds onsite in all CAHs.

Access to the other imaging services increased at an average of seven percent when access to services through external arrangements was assessed.

“These findings potentially have enormous imaging service policy implications,” wrote the authors. “Given the substantial variation in the scope and spectrum of imaging availability across CAHs, future research should investigate how this variation affects patient care in this setting,” they concluded.