Why do people miss MRIs? Race, money might have something to do with it

The greater the window of time between scheduling an MRI and showing up for the exam, the more likely a patient is to miss the appointment altogether, according to data published in the Journal of the American College of Cardiology—and the effect is especially pronounced in minority populations.

Research led by Dania Daye, MD, PhD, and colleagues at Massachusetts General Hospital in Boston found that advanced diagnostic imaging (ADI), while a key component of high-quality healthcare in the U.S., presents racial, ethnic and socioeconomic challenges across the country. Those divisive lines are already well-established in many areas of American life, Daye et al. said, but “radiology is no exception.”

Black and Hispanic women have historically seen longer follow-up times for additional imaging after abnormal mammogram results, according to the study, and uninsured patients are referred less frequently for imaging exams in the emergency room setting. Wealthy, white patients, rather than those of color or a lower socioeconomic standing, are also more likely to show up to an MRI or CT appointment.

“In the era of population health management, radiologists have become increasingly important as stewards of appropriate utilization of advanced imaging services,” the authors wrote. “Radiologists have an important role and responsibility to minimize barriers and disparities in access to these high-value imaging services.”

As far as ADI spending goes, MRIs still have the highest price tag, Daye and co-authors said. Magnetic resonance imaging is costlier than both CT scans and ultrasounds, and the additional money is just one factor limiting access to the machines.

“Access to and availability of MRI appointments may also be limited because of longer examination duration and requirements for highly trained staff members,” the researchers wrote. “Therefore, when an MRI appointment is missed, the losses to the healthcare system and to other patients who could have accessed the system sooner are magnified.”

For their paper, Daye and colleagues retrospectively studied data from 42,727 adult patients who were scheduled for an MRI during a 12-month period. Mean wait days—the number of days between scheduling an appointment and the appointment itself—were nearly 8 at baseline.

The authors found that as wait days increased linearly, so did the likelihood of a patient missing their exam. Black patients, Hispanic patients, those with noncommercial insurance and patients whose imaging exams were performed at the hospital’s main campus were also less likely to make it to their scheduled appointment, the study stated.

The number of minority patients who missed their exams could be the result of a handful of circumstances, Daye et al. wrote, including disparities in health literacy and perceived disrespect or mistrust of the healthcare system. Implementing strategies, like increasing capacity or allowing more flexible scheduling, to reduce wait days could be crucial to improving follow-through rates.

“Increased time from scheduling to performance of MRI is associated with increased rates of imaging missed appointments,” the authors said. “Increasing access and capacity to MRI services may provide an opportunity to improve equity in access to care for all patients.”