COVID-19 brought 'overt' care-rationing in radiology that’s worsening disparities. How to fix it
The COVID-19 pandemic has brought “overt” care rationing in radiology and other branches of medicine that may be worsening disparities in minority populations, experts wrote Wednesday.
Examples include everything from canceling elective procedures during case surges to scheduling fewer imaging appointments to allow for social distancing and more cleanup time. Several studies have detailed how the crisis has impacted imaging, including one last week, which found substantial drops in breast cancer diagnoses among Asian, Latina and Black women.
Radiologists believe the profession must act to address these deficits, according to a new opinion piece published in the Journal of the American College of Radiology.
“Even as imaging utilization rates normalize post-pandemic, disproportionately negative health outcomes for some socioeconomically disadvantaged populations will persist unless imaging utilization for these groups exceeds historic levels,” Stephen Brown, MD, with the Department of Radiology at Boston Children’s Hospital, and colleagues wrote Oct. 20. “By understanding fundamental tenets of rationing, we can improve radiology resource utilization guidelines and help correct chronic disparities that have been recently exacerbated by the pandemic.”
Brown et al. believe “abundant opportunities” exist to mitigate disparities, improve access, and undo such care rationing. For instance, recently revised lung cancer screening guidelines with lower age and smoking pack-years recommendations will help expand access for minority populations. However, implementation will take time and may not overcome pandemic-related care gaps. The writers suggest using “equity-weighted allocation strategies” to better target populations left un-imaged amid the pandemic.
“If we choose, radiologic resource allocation frameworks could create weighting systems specifically favoring populations most affected by ongoing disparities,” the authors advised. “Just as proposed vaccine allocation systems create weighted mechanisms facilitating advantaged access for worst-off neighborhoods, perhaps allocation guidelines could establish mechanisms whereby patients meeting similar criteria are targeted for enhanced access. Measures might include proactively scheduling patients from neighborhoods whose rebounding volumes have lagged post-pandemic and those experiencing the most severe and enduring disparities. Accordingly, neighborhood metrics might be integrated into patient scheduling software similarly to how they can be incorporated into vaccination algorithms.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.