The effects of race, primary language, insurance, and other factors on time to pediatric outpatient MRI completion

Purpose: Racial and ethnic disparities have been shown to exist in access to medical care in the United States. The purpose of this study was to determine the discrepancies in time to outpatient MRI scheduling and completion by race, ethnicity, primary language, socioeconomic status, insurance and other factors at our tertiary children's hospital.

Methods/Materials: After obtaining Institutional Review Board approval, we retrospectively extracted data from all outpatient MRI exams completed at our tertiary children's hospital between 10/5/2020 and 8/31/2022. Collected data included gender, age, race/ethnicity, primary language, medical complexity, insurance type, address, need for anesthesia, ordering specialty, and order acuity. We determined times to event (MRI scheduling or completion) using mixed effects Cox regression models and determined associations between unadjusted and fully adjusted models.

Results: We analyzed 14,002 outpatient MRI orders from 9,714 unique patients. 56.2% were White, 19.2% Hispanic, 8.4% Asian, 7.2% Native Hawaiian/Pacific Islander, 5.7% two or more races/ethnicities, 4.5% Black/African American, 1.4% American Indian/Alaska Native, and 3.8% "Other." In fully adjusted models, there was no significant association between race/ethnicity and time to MRI scheduling and completion, adjusting for primary language (English vs non-English), medical complexity, area deprivation index, need for anesthesia, insurance type, and ordering specialty. In unadjusted models, Hispanic patients had slightly slower than average time to MRI scheduling/completion [hazard ratio (95% confidence intervals) of 0.94 (0.90, 0.98) and 0.91 (0.87, 0.96)] and Asian patients had slightly faster than average time to MRI scheduling/completion [hazard ratio (95% confidence intervals) of 1.12 (1.04, 1.20) and 1.16 (1.07, 1.25)]. Adjusted time to completion of MRI was slower among those with Medicaid, a primary language other than English, chronic illness, and need for anesthesia.

Conclusions: At our tertiary children's hospital, time to completion of outpatient MRI was slower among those with Medicaid, primary language other than English, and need for anesthesia. Patient race did not affect time to complete MRI.