Analysis of Rural Disparities in Ultrasound Access

Abstract

Purpose This work aims to conduct a geospatial analysis of recent ultrasound access and usage within the United States, with a particular focus on disparities between rural and urban areas. Methods/Materials Multiple public datasets were merged on a county level, including US Department of Agriculture economic metrics and Centers for Medicare Services data using the most recent years available (2015-2019). From these databases, 39 total variables encompassing the socioeconomic, health, and ultrasound characteristics of each county were obtained. Current Procedural Terminology (CPT) codes incorporated included ultrasound-guided procedures and diagnostic exams. Three thousand eleven counties were included. The combined dataset was then exported to GeoDa for network-based analysis and to produce map visualizations. To identify statistically significant (p < 0.05) hotspots and coldspots in point-of-care ultrasound (POCUS) prevalence, Moran’s I was used. Choropleth maps were created for visualization. ANOVA was run across the four Moran’s I groups for each of 39 variables of interest. Results A total of 30,135,085 ultrasound-related CPT codes were billed to Medicare over 2015-2019, with 26.55% of codes being ultrasound-guided procedures and 73.45% being diagnostic exams. 38.84% of rural counties had access to POC ultrasound compared to 88.56% of metropolitan counties and 74.19% of counties overall. Hotspots of POCUS were in Southern California and the Eastern US (average of 1,441 per 10,000 Medicare members per year). Coldspot areas were seen in the Great Plains and Midwest (average of 7.43 per 10k Medicare members per year). Hotspot clusters, when compared to coldspot clusters, were significantly (p < 0.001) more dense (703.6 to 14.9 people per square mile), more urbanized (3.5 to 7.1 Rural-Urban Continuum (RUC)), more college-educated (25.1% to 20.0%), more likely to have an Emergency Department (ED) visit (725.8 to 616.9 visits per 1,000 Medicare members), more likely to be obese (19.0% to 12.9%), less likely to be uninsured (10.1% to 13.0%), had more Black representation (8.5% to 3.4%), and less Hispanic representation (2.6% to 5.5%). Conclusions Ultrasound access and usage demonstrate significant geospatial trends across the United States. Hotspot and coldspot counties differ on several key sociodemographic and economic variables.

Canadian midwives’ perspectives on the clinical impacts of point of care ultrasound in obstetrical care: A concurrent mixed-methods study

“…In Saskatchewan, 64% of pregnant individuals in urban centres had a second trimester ultrasound while only 9% of participants in rural areas had this scan [ 29 ]. In the United States, only approximately 39% of rural areas across the country had POCUS access [ 30 ]. Our research provides an example from a high-income country which supports the findings from other low- and middle-income countries about the value of midwifery-led bedside scanning as a way to facilitate opportunities for patients to access sonography [ 3 , [8] , [9] , [10] ].…”

Artificial Intelligence to Determine Fetal Sex

“…The available options for fetal sex determination require a skilled sonographer, obstetrician review, expensive lab test, or an invasive procedure. This may serve as a barrier where the advancement of technology or resource availability is not afforded, such as low or middle income countries [12,13]. A viable artificial intelligence (AI) model for fetal sex determination could be of significant value to providers in these settings, as it would be agnostic to sonographer's abilities and skillset.…”

“…This may serve as a barrier where the advancement of technology or resource availability is not afforded, such as low-or middle-income countries. 12,13 A viable AI model for fetal sex determination could be of significant value to providers in these settings, as it would be agnostic to sonographer's abilities and skillset. This proof-of-concept study assessed how confidently an AI model can determine the sex of a fetus from an ultrasound image.…”

Point‐counterpoint: Should point‐of‐care ultrasound be a required skill of hospitalists?

“…Only 56% of state critical access hospitals have computerized tomography scanners and 33% have the capability to offer referral diagnostic ultrasound exams performed by a sonographer and interpreted by a radiologist 23 . Another study shows that only 39% of rural counties in the United States have access to POCUS, compared to 89% in metropolitan counties 24 . Since many rural and critical access hospitals are staffed primarily by hospitalists, requiring POCUS skills of all hospitalists would enhance POCUS availability in these resource‐limited settings, allowing clinicians to improve accuracy and rapidity of bedside diagnosis, streamline diagnostic workups, and transfer patients expeditiously when indicated.…”

“…23 Another study shows that only 39% of rural counties in the United States have access to POCUS, compared to 89% in metropolitan counties. 24…”