PURA-ECHO: Analysis of the evolution of Ultrasound utilization in austere health care settings in Costa Rica's Geographic Empanelment Model
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Background The POCUS Utilization in Resource Austerity – Echocardiography (PURA-ECHO) study examines the evolution of both formal and Point-of-Care Ultrasound (POCUS) utilization within Costa Rica’s national healthcare system (CCSS) under a geographic empanelment model. This study investigates the impact of geographic factors on ultrasound adoption over time in rural, resource-limited Emergency Departments and urgent care centers. Methods PURA-ECHO is a retrospective review of the CCSS database comparing ultrasound utilization at rural and urban Emergency Departments and urgent care clinics from 2006 to 2022. The primary outcome was the change in the number of POCUS and formal ultrasound exams performed in rural versus urban centers over time. Geospatial mapping generated topographical representations of ultrasound use, and linear regression evaluated the relationship between distance from urban centers and ultrasound utilization in rural areas. Results Between 2006 and 2022, ultrasound utilization increased significantly following geographic empanelment. Rural centers showed a greater overall increase in ultrasound exams (323%) compared to urban centers (154%) (p < 0.05). A strong inverse relationship was observed between distance from an urban center and ultrasound adoption in rural areas (R² = 0.77). Geospatial analysis underscored the more robust growth of ultrasound utilization in rural healthcare settings compared to urban ones. Conclusion Our analysis demonstrates that ultrasound utilization expanded more rapidly in rural healthcare centers than in urban centers within the context of a Geographic Empanelment Model. Increased distance from urban centers was associated with a smaller increase in ultrasound adoption. These findings suggest that targeted efforts to integrate both formal and POCUS modalities in geographically isolated regions can enhance diagnostic capacity in resource-limited settings.
