Purpose or Case Report: To analyze regional disparities in imaging utilization over an 8-year period in one of the largest pediatric Accountable Care Organizations (ACO) in the US covering over 300,000 children.
Methods & Materials: Claims data for each year from 2010-2017 were reviewed to obtain MRI, CT, and US utilization from emergency department (ED) and outpatient (OP) encounters. The county name for each child’s residency was recorded, and the total number of children covered in each county was obtained. Median family income and for these counties were obtained from 2010 US Census. Utilization rate (UR, defined as number of advanced imaging procedures per 100 enrolled children per year) was calculated for each county. Linear trend analysis were undertaken using Pearson’s correlation.
Results: Children from 34 different counties presented for a total of 95,326 ED procedures and 154,255 OP procedures over the 8-year period. Through the ED, there was significant differences in UR across counties, with median global UR of 3.8 (min= 2.1; max=6.1), median UR for CT of 3.1 (min=1.0; max=4.8), median UR for US of 0.8 (min=0.4; max=1.6), and median UR for MRI of 0.04 (min=0.02; max=0.09). Comparing median family income to UR in the ED, there was a moderate negative correlation for global usage (Pearson’s r=-0.4) and CT usage (r=-0.54). US usage in the ED had a marginal positive correlation with increasing family income (r=0.29). In the OP setting, significant differences in UR were again noticed across counties, with median global UR noted as 5.8 (min= 4.0; max=8.0), median UR for CT of 1.1 (min=0.6, max=2.1), median UR for US of 3.0 (min=2.3, max=4.0), and median UR for MRI of 1.6 (min=1.1; max = 2.0). Comparing median family income to UR in the OP setting, there was a moderate negative correlation for all usages: global usage (Pearson’s r=-0.47), CT usage (r=-0.44), US usage (r=-0.32), and MRI usage (r=-0.50).
Conclusions: This is one of the few studies examining geographic disparities in pediatric imaging utilization. There is significant variation in utilization by patients from 34 counties with more pronounced difference in the ED vs. OP setting. In addition, there is a moderate negative correlation between advanced imaging utilization and median family income of the county. Knowing regional disparities in pediatric imaging utilization may help explain some differences in health outcomes for disease-specific pathways and help develop targeted interventions and allocate future resources appropriately.