Safety Net Hospitals Address Barriers to High-Quality Care

This is the fifth in a series of articles addressing health care equity and the solutions radiology can implement. Read part one, part two, part three and part four. View the health care equity infographic for details on how RSNA is working to promote diverse representation across the profession and within its leadership.

Radiologists at safety net institutions face obstacles at all stages of imaging as they care for patients.

“These obstacles are often complex, interrelated and difficult to address within the context of considerable resource constraints,” said Jinel Scott, MD, MBA, associate professor of clinical radiology in the Department of Radiology at SUNY Downstate Health Sciences University, and director of emergency radiology, quality improvement and patient safety in the Department of Radiology at NYC Health + Hospitals/Kings County.

Both institutions where Dr. Scott provides care are safety net hospitals. In the U.S., these hospitals care for patients who are uninsured or unable to pay for medical treatment.

Increased Screening Access Improves Outcomes

One major challenge at safety net institutions is limited financial and human resources, which can make it difficult to initiate and properly manage imaging and screening programs. Dr. Scott points to the Healthy Lungs Program at NYC Health + Hospitals/Kings County, which offers lung cancer screening, as an example.

“Though lung cancer screening has been proven efficacious in decreasing the mortality associated with lung cancer based on early detection, it was a challenge to bring this service to the community,” Dr. Scott said. “It required significant multidisciplinary consensus building and dedication by physicians and institutional leadership to acquire the necessary funding and support.” Stephen Waite, MD, director of the Healthy Lungs Program, is optimistic that such screening programs can help with early diagnosis, enabling more patients to survive a lung cancer diagnosis. Since its inception in June 2021, more than 167 patients have been screened.

“Thus far, we have a very high percentage of positive cases compared to the original data from the National Cancer Institute’s National Lung Screening Trial, demonstrating the importance of this program in our community,” said Dr. Waite, who also serves as director of cardiothoracic imaging at NYC Health + Hospitals/ Kings County and clinical associate professor of radiology and internal medicine at SUNY Downstate Health Sciences University.

Other data underscore the need for increased screenings at safety net institutions. Research presented at RSNA 2021 found that less than 25% of patients at a Boston Medical Center received yearly mammograms.

“Patients with Medicaid were almost 50% less likely to receive mammograms than privately insured patients. We also found that in patients diagnosed with late-stage tumors, their average screening interval was more than a year longer than the patients diagnosed with early staged cancers,” said Alex Boyko, a fourth-year medical student at Boston University School of Medicine, who presented a scientific poster on the impact of demographic and financial disparities on breast cancer mortality. “Nearly 70% of the patient deaths occurred in patients who had not been screened within the past 750 days or at all.”