Utilization of Radiography Services in an Academic Medical Center Partnership with a Federally Qualified Health Center Network: A Cross Sectional Study

Purpose: Federally qualified health centers (FQHC) serve medically underserved populations. In 2013, UW Health, the integrated health system of the University of Wisconsin, partnered with Access Community Health Centers (ACHC), the FQHC network in Madison, WI to provide on-site outpatient imaging services. This study characterized the utilization of radiography services associated with the UW Health-ACHC partnership in comparison with other UW Health outpatient imaging sites.

Methods/Materials: We included electronic health record data from January 2013 to December 2022 on all outpatient x-rays completed at UW Health imaging sites. We compared demographic characteristics between patients ever seen at ACHC clinics with patients seen only at non-ACHC UW Health clinics using chi-square and t-tests. Rural-Urban Commuting Area codes and Social Deprivation Index (SDI) were determined for patient ZIP codes. Unadjusted and adjusted logistic regression were used to assess predictors of imaging utilization at ACHC clinics.

Results: Over the study period, 4% (23,794/650,685) of imaging encounters occurred at ACHC sites and 4% (10,986/246,104) of patients used ACHC facilities at least once. The most common radiographs at ACHC clinics were musculoskeletal (68%), chest (28%), and abdominal (4%). Patients ever seen at ACHC clinics versus patients seen only at non-ACHC UW Health clinics were younger (mean age 41 vs. 42 years) and more often female (55% vs. 53%), Black or African American (22% vs. 5%), Hispanic/Latino (34% vs. 4%), Asian (5% vs. 3%), with Medicaid (33% vs. 9%), and uninsured (18% vs. 4%) (p < 0.001). Patients at ACHC clinics more often lived in metropolitan areas (98% vs. 88%) with higher social deprivation (mean SDI 53 vs. 31) (p < 0.001) (Figure 1). In multivariable analyses, patients from racial/ethnic minority groups, without commercial insurance, residing in a metropolitan area, and with a non-English primary language were independently more likely to ever use ACHC radiography services (p < 0.001).

Conclusions: FQHCs represent trusted, community health centers serving medically underserved populations. Partnerships between academic institutions and FQHCs can increase geographic imaging access among these groups.