The Effect of Patient Race on Total Joint Replacement Recommendations and Utilization in the Orthopedic Setting
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The extent to which treatment recommendations in the orthopedic setting contribute to well-established racial disparities in the utilization of total joint replacement (TJR) in the treatment of advanced knee/hip osteoarthritis has not been explored.
To examine whether orthopedic surgeons are less likely to recommend TJR to African-American patients compared to white patients with similar clinical indications, and whether there are racial differences in the receipt of TJR within six months of study enrollment.
Prospective, observational study.
African-American (AA; n = 120) and white (n = 337) patients seeking treatment for knee or hip osteoarthritis in Veterans Affairs orthopedic clinics.
Patients completed surveys that assessed socio-demographic and clinical variables that could influence osteoarthritis treatment. Orthopedic surgeons’ notes were reviewed to determine whether patients had been recommended for TJR and whether they underwent the procedure within 6 months of study enrollment.
Rate of TJR recommendation was 19.5%. Odds of receiving a TJR recommendation were lower for AA than white patients of similar age and disease severity (OR = 0.46, 95% CI = 0.26–0.83; P = 0.01). However, this difference was not significant after adjusting for patient preference for TJR (OR = 0.69, 95% CI = 0.36–1.31, P = 0.25). Overall, 10.3% of patients underwent TJR within 6 months. TJR was less likely for AA patients than for white patients of similar age and disease severity (OR = 0.41, 95% CI = 0.16–1.05, P = 0.06), but this difference was reduced after adjusting for whether patients had received a recommendation for the procedure at the index visit (OR = 0.57, 95% CI = 0.21–1.54, P = 0.27).
In this study, race differences in patient preferences for TJR appeared to underlie race differences in TJR recommendations, which led to race differences in utilization of the procedure. Our findings suggest that patient treatment preferences play an important role in racial disparities in TJR utilization in the orthopedic setting.
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- The Effect of Patient Race on Total Joint Replacement Recommendations and Utilization in the Orthopedic Setting
Journal of General Internal Medicine
Volume 25, Issue 9 , pp 982-988
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- healthcare disparities
- total joint replacement
- orthopedic surgery
- patient preference
- Industry Sectors
- Leslie R. M. Hausmann PhD (1)
- Maria Mor PhD (1) (2)
- Barbara H. Hanusa PhD (1) (3)
- Susan Zickmund PhD (1) (4)
- Peter Z. Cohen MD (4)
- Richard Grant MD (5) (6)
- Denise M. Kresevic RN, PhD (5) (6)
- Howard S. Gordon MD (7) (8)
- Bruce S. Ling MD (1) (4)
- C. Kent Kwoh MD (1) (4)
- Said A. Ibrahim MD, MPH (10) (9)
- Author Affiliations
- 1. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, 7180 Highland Drive (151C-H), Pittsburgh, PA, 15206, USA
- 2. Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- 3. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- 4. School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- 5. Louis Stokes DVA Medical Center, Cleveland, OH, USA
- 6. University Hospitals Case Medical Center, Cleveland, OH, USA
- 7. Jesse Brown VA Medical Center, Center for Complex Chronic Care, Chicago, IL, USA
- 8. College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
- 10. School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- 9. Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA, USA