Radiology referrals patterns in a free clinic setting

Abstract

Purpose: To evaluate imaging referral completion rates in an urban, free clinic for underserved patients, including associated patient and imaging factors.

Materials and methods: In this IRB-approved single-center study, we retrospectively analyzed imaging referral orders associated with an urban, outpatient, free clinic from January 2017 to December 2022. Referrals were submitted to a tertiary academic center with the exception of a subset of ultrasound referrals that were processed onsite at a point-of-care ultrasound (POCUS) clinic, and a proportion of mammography referrals completed within mobile imaging units. Associations between patient and imaging-specific factors - and referral completion rates - were further evaluated.

Results: A total of 882 referrals were submitted for 629 unique patients (average age, 48 years; 67 % female). Of total referrals, 424 (48 %) were successfully completed. Of the major represented modalities, ultrasound was completed at a rate of 59 % compared to x-rays which were completed at a rate of 45 % and mammography which was completed at a rate of 37 %. On-site imaging services, namely POCUS and mobile mammography, led to more successfully completed imaging (77 % combined success rate) than off-site services (p < 0.0001). Patients for whom "Unknown" was documented for race/ethnicity identification (14 % of submissions) and language preference (9 % of submissions) were least likely to have successful completion of their referral (p < 0.0001).

Conclusion: Low success rates of completion for imaging referrals from our free clinic indicate the need for further efforts to ensure high-quality imaging care for corresponding patient populations, with mobile and point-of-care imaging being of potential utility.

Keywords: Disparities; Free clinic; Mobile imaging; On-site imaging; Radiological access.