Design Measurement and Evaluation / Enseignement : pratiques et évaluation A Rural CT Scanner: Evaluating the Effect on Local Health Care Barbara J Merkens, PhD; R Douglas Mowbray, MD, FRCPC; Larry Creeden, MRT; Paul T Engels, MD; Deanna M Rothwell, BSc, MSc; Benjamin TB Chan, MD, MPA; Karen Tu, MD, MSc Abstract Objective: The first small rural hospital in Ontario to propose a computed tomography (CT) scanner was in Walkerton, a town 160 km north of London. The Ontario Ministry of Health approved the proposal as a pilot project to evaluate the effect on local health care of a rural scanner. This evaluation study had 3 parts: a survey of physicians, a survey of patients, and an analysis of population CT scanning rates. Method: The physicians in the area served by the scanner were asked about its impact on their care of their patients in a mailed questionnaire and in semistructured interviews. Scanner outpatients were given a questionnaire in which they rated the importance of its advantages. The analysis of scanning rates—the ratio of number of scans to estimated population—compared rates in the area with other Ontario rates before and after the scanner was introduced. Results: The physicians reported that local CT allowed them to diagnose and treat patients sooner, closer to home, and with greater confidence. On average, 75% of the patients ranked faster and closer access as very important. Scanning rates in the area rose, although they did not match urban rates. Conclusions: The study confirms that the rural scanner changed the area’s health care in significant ways and that it helped to narrow the gap between rural and urban service levels. We recommend that CT be expanded to other rural regions. Abrégé Objectif : Le premier hôpital rural de l’Ontario qui a proposé un tomodensitomètre (CT) se situait à Walkerton, une ville à 160 Km au nord de London. Le ministre de la Santé de l’Ontario a approuvé la proposition à titre de projet pilote, afin d’évaluer l’effet d’un scanner rural sur les soins de santé locaux. Cette étude d’évaluation comporte 3 parties : un sondage auprès des médecins, un sondage auprès des patients et une analyse des taux de tomodensitométrie dans la population. Méthode : On a interrogé les médecins de la région ayant accès au scanner à propos de l’effet de celui-ci sur les soins de leurs patients, au moyen d’un questionnaire posté et d’entrevues semi-structurées. On a remis aux patients externes du scanner un questionnaire dans lequel ils cotaient l’importance de ses avantages. L’analyse des taux de tomodensitométrie – le ratio du nombre de d’imageries et de la population estimée – comparait les taux avec d’autres taux de l’Ontario avant et après l’introduction du scanner. Résultats : Les médecins ont déclaré que le CT local leur permettait de diagnostiquer et de traiter leurs patients plus tôt, plus près de chez eux et avec une plus grande assurance. En moyenne, 75 % des patients jugeaient très important un accès plus rapide et plus près. Les taux de tomodensitométrie ont augmenté dans la région, mains ne correspondaient pas aux taux urbains. 224 JACR vol 57, n o 4,octobre 2006 Merkens—Barbara Merkens and Associates, Don Mills, ON Mowbray, Creeden—Department of Diagnostic Imaging, South Bruce Grey Health Centre, Walkerton, ON Engels—Faculty of Medicine & Dentistry, University of Western Ontario, London, ON Rothwell—Institute for Clinical Evaluative Sciences, Toronto, ON Chan—Institute for Clinical Evaluative Sciences, Department of Family and Community Medicine, Department of Health Policy Evaluation and Management, and Department of Public Health Sciences, University of Toronto, Toronto Tu—Institute for Clinical Evaluative Sciences, Department of Family and Community Medicine, University of Toronto, Toronto, ON Address for correspondence: Barbara J Merkens, Barbara Merkens and Associates, 180 Three Valleys Drive, Don Mills, ON M3A 3L8; phone 416-445-2653 Received October 6, 2005 Revision requested December 13, 2005 Resubmitted February 28, 2006 Accepted March 3, 2006 ©2006 Canadian Association of Radiologists Can Assoc Radiol J 2006;57(4):224–231. Key Words: rural health services; computed tomography; equity; access