Factors Associated With Timeliness and Equity of Access to Outpatient MRI Examinations

Ronilda Lacson; Oleg Pianykh; Sean Hartmann; Heather Johnston; Dania Daye; Efren Flores; Neena Kapoor; Ramin Khorasani

doi:10.1016/j.jacr.2023.12.028

Factors Associated With Timeliness and Equity of Access to Outpatient MRI Examinations

J Am Coll Radiol. 2024 Jan 10:S1546-1440(24)00001-2. doi: 10.1016/j.jacr.2023.12.028. Online ahead of print.

Authors

Ronilda Lacson¹, Oleg Pianykh², Sean Hartmann³, Heather Johnston³, Dania Daye⁴, Efren Flores⁵, Neena Kapoor⁶, Ramin Khorasani⁷

Affiliations

¹ Associate Director of Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, and Associate Professor of Radiology, Harvard Medical School, Boston, Massachusetts. Electronic address: rlacson@bwh.harvard.edu.
² Assistant Professor of Radiology, Harvard Medical School, Boston, Massachusetts, and Director of Medical Analytics, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
³ Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
⁴ Assistant Professor of Radiology, HMS, Harvard Medical School, Boston, Massachusetts, and Quality Director, Interventional Radiology Division, and Co-Director of IR Research, Division of Vascular and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
⁵ Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, and Associate Professor of Radiology, Harvard Medical School, Boston, Massachusetts; Vice Chair, Diversity, Equity & Inclusion, Mass General Brigham; Vice Chair of Radiology, and Distinguished Chair, Medical Informatics, and Director of Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, and Professor of Radiology, Harvard Medical School, Boston, Massachusetts; Vice Chair, Radiology Quality and Safety, Mass General Brigham.
⁶ Director of Diversity, Inclusion, and Equity and Quality and Safety Officer, Department of Radiology, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, and Assistant Professor of Radiology, Harvard Medical School, Boston, Massachusetts.
⁷ Vice Chair of Radiology, and Distinguished Chair, Medical Informatics, and Director of Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, and Professor of Radiology, Harvard Medical School, Boston, Massachusetts; Vice Chair, Radiology Quality and Safety, Mass General Brigham.

PMID: 38215805
DOI: 10.1016/j.jacr.2023.12.028

Abstract

Objective: The role of MRI in guiding patients' diagnosis and treatment is increasing. Therefore, timely MRI performance prevents delays that can impact patient care. We assessed the timeliness of performing outpatient MRIs using the socio-ecological model approach and evaluated multilevel factors associated with delays.

Methods: This institutional review board-approved study included outpatient MRI examinations ordered between October 1, 2021, and December 31, 2022, for performance at a large quaternary care health system. Mean order-to-performed (OtoP) interval (in days) and prolonged OtoP interval (defined as >10 days) for MRI orders with an expected date of 1 day to examination performance were measured. Logistic regression was used to assess patient-level (demographic and social determinants of health), radiology practice-level, and community-level factors associated with prolonged OtoP interval.

Results: There were 126,079 MRI examination orders with expected performance within 1 day placed during the study period (56% of all MRI orders placed). After excluding duplicates, there were 97,160 orders for unique patients. Of the MRI orders, 48% had a prolonged OtoP interval, and mean OtoP interval was 18.5 days. Factors significantly associated with delay in MRI performance included public insurance (odds ratio [OR] = 1.11, P < .001), female gender (OR = 1.11, P < .001), radiology subspecialty (ie, cardiac, OR = 1.71, P < .001), and patients from areas that are most deprived (ie, highest Area Deprivation Index quintile, OR = 1.70, P < .001).

Discussion: Nearly half of outpatient MRI orders were delayed, performed >10 days from the expected date selected by the ordering provider. Addressing multilevel factors associated with such delays may help enhance timeliness and equity of access to MRI examinations, potentially reducing diagnostic errors and treatment delays.

Keywords: Diagnostic error; MRI; health equity; outpatient care.