title: The Impact of Hospital Characteristics on the Availability of Radiology Services at Critical Access Hospitals.
abstract: OBJECTIVE
  Although all critical access hospitals (CAHs) provide basic medical and radiographic imaging services, it remains unclear how CAHs provide additional imaging services given relatively low patient volumes and high resource costs. The aim of this study was to examine whether CAHs with more resources or access to resources through affiliation with larger systems are more likely to offer other imaging services in their communities.
  
  
  METHODS
  Linking data from the American Hospital Association's annual hospital surveys and the American Hospital Directory's annual surveys from 2009 to 2011, multivariate logistic regressions were performed to estimate the likelihood of individual CAHs with greater financial resources or network affiliations providing specific imaging services (MRI, CT, ultrasound, mammography, and PET/CT), while adjusting for the number of beds, personnel, inpatient revenue share, case mix, rural status, year, and geographic location.
  
  
  RESULTS
  Hospital total expenditures were positively associated with the provision of MRI (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.07-1.19), mammography (OR, 1.11; 95% CI, 1.01-1.16), and PET/CT (OR, 1.04; 95% CI, 1.01-1.06). Network affiliation was positively associated with the availability of MRI (OR, 1.75; 95% CI, 1.27-2.39), CT (OR, 2.17; 95% CI, 1.15-4.09), ultrasound (OR, 2.03; 95% CI, 1.17-3.52), and mammography (OR, 2.00; 95% CI, 1.47-2.71). Rural location was negatively associated with the availability of PET/CT (OR, 0.65; 95% CI, 0.49-0.88).
  
  
  CONCLUSIONS
  Total hospital expenditures and network participation are important determinants of whether CAHs provide certain imaging services. Encouraging CAHs' participation in larger systems or networks may facilitate access to highly specialized services in rural and underserved areas.
authors.affiliation: Department of Health Administration and Policy, University of Oklahoma Health Sciences Center, College of Public Health, Oklahoma City, Oklahoma. Electronic address: amir-khaliq@ouhsc.edu.
authors.forename: Amir A
authors.initials: AA
authors.lastname: Khaliq
authors.affiliation: Harvey L. Neiman Health Policy Institute, Reston, Virginia; Department of Economics, George Mason University, Fairfax, Virginia.
authors.forename: Darwyyn
authors.initials: D
authors.lastname: Deyo
authors.affiliation: Harvey L. Neiman Health Policy Institute, Reston, Virginia; Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Richard
authors.initials: R
authors.lastname: Duszak
mesh_terms: D003952:Diagnostic Imaging / Q000191:economics* / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data*; D006780:Hospitals, Rural / Q000145:classification / Q000191:economics* / Q000600:supply & distribution*; D011871:Radiology / Q000191:economics / Q000706:statistics & numerical data; D014481:United States
keywords: Critical access hospitals; medical imaging; rural hospitals