The effect of patient race on total joint replacement recommendations and utilization in the orthopedic setting

Leslie R.M. Hausmann; Maria Mor; Barbara H. Hanusa; Susan Zickmund; Peter Z. Cohen; Richard Grant; Denise M. Kresevic; Howard S. Gordon; Bruce S. Ling; C. Kent Kwoh; Said A. Ibrahim

doi:10.1007/s11606-010-1399-5

The effect of patient race on total joint replacement recommendations and utilization in the orthopedic setting

Leslie R.M. Hausmann, Maria Mor, Barbara H. Hanusa, Susan Zickmund, Peter Z. Cohen, Richard Grant, Denise M. Kresevic, Howard S. Gordon, Bruce S. Ling, C. Kent Kwoh, Said A. Ibrahim

Research output: Contribution to journal › Article › peer-review

103 Scopus citations

Abstract

BACKGROUND: 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. OBJECTIVE: 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. DESIGN: Prospective, observational study. PARTICIPANTS: African-American (AA; n = 120) and white (n = 337) patients seeking treatment for knee or hip osteoarthritis in Veterans Affairs orthopedic clinics. MAIN MEASURES: 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. RESULTS: 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). CONCLUSIONS: 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.

Original language	English (US)
Pages (from-to)	982-988
Number of pages	7
Journal	Journal of General Internal Medicine
Volume	25
Issue number	9
DOIs	https://doi.org/10.1007/s11606-010-1399-5
State	Published - Sep 2010
Externally published	Yes

Keywords

healthcare disparities
orthopedic surgery
osteoarthritis
patient preference
total joint replacement

ASJC Scopus subject areas

Internal Medicine

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10.1007/s11606-010-1399-5

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Hausmann, L. R. M., Mor, M., Hanusa, B. H., Zickmund, S., Cohen, P. Z., Grant, R., Kresevic, D. M., Gordon, H. S., Ling, B. S., Kwoh, C. K., & Ibrahim, S. A. (2010). The effect of patient race on total joint replacement recommendations and utilization in the orthopedic setting. Journal of General Internal Medicine, 25(9), 982-988. https://doi.org/10.1007/s11606-010-1399-5

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title = "The effect of patient race on total joint replacement recommendations and utilization in the orthopedic setting",

abstract = "BACKGROUND: 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. OBJECTIVE: 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. DESIGN: Prospective, observational study. PARTICIPANTS: African-American (AA; n = 120) and white (n = 337) patients seeking treatment for knee or hip osteoarthritis in Veterans Affairs orthopedic clinics. MAIN MEASURES: 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. RESULTS: 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). CONCLUSIONS: 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.",

keywords = "healthcare disparities, orthopedic surgery, osteoarthritis, patient preference, total joint replacement",

author = "Hausmann, {Leslie R.M.} and Maria Mor and Hanusa, {Barbara H.} and Susan Zickmund and Cohen, {Peter Z.} and Richard Grant and Kresevic, {Denise M.} and Gordon, {Howard S.} and Ling, {Bruce S.} and Kwoh, {C. Kent} and Ibrahim, {Said A.}",

note = "Funding Information: Acknowledgements: This study was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development Service (IIR 04-137, PI: Said A. Ibrahim). Dr. Hausmann{\textquoteright}s effort was supported by the Veterans Affairs Health Services Research and Development Career Development Program (RCD 06-287 and ER 0280-1). Dr. Ibrahim is a previous recipient of a VA Health Services Research Career Development Award and the Harold Amos Robert Wood Johnson Scholar Award. Dr. Ibrahim is also supported by a K24 Award (1K24AR055259-01) from the National Institutes of Musculoskeletal and Skin Disorders. The views expressed here are those of the authors and do not represent those of the Department of Veterans Affairs or the United States Government. The authors would like to thank project coordinator Margaret Kerr and members of the research staff: Elizabeth Flatley, Michael Hannon, Laura Johnson, Renee McDade, Matthew McShane, Rebecca Meiksin, Christine Schneider, Rebecca Siders, Lisa Stewart, and Sandra Truax. The authors would also like to thank Kim Hansen and Hilary Peterson for editorial input on this manuscript.",

year = "2010",

month = sep,

doi = "10.1007/s11606-010-1399-5",

language = "English (US)",

volume = "25",

pages = "982--988",

journal = "Journal of General Internal Medicine",

issn = "0884-8734",

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TY - JOUR

T1 - The effect of patient race on total joint replacement recommendations and utilization in the orthopedic setting

AU - Hausmann, Leslie R.M.

AU - Mor, Maria

AU - Hanusa, Barbara H.

AU - Zickmund, Susan

AU - Cohen, Peter Z.

AU - Grant, Richard

AU - Kresevic, Denise M.

AU - Gordon, Howard S.

AU - Ling, Bruce S.

AU - Kwoh, C. Kent

AU - Ibrahim, Said A.

N1 - Funding Information: Acknowledgements: This study was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development Service (IIR 04-137, PI: Said A. Ibrahim). Dr. Hausmann’s effort was supported by the Veterans Affairs Health Services Research and Development Career Development Program (RCD 06-287 and ER 0280-1). Dr. Ibrahim is a previous recipient of a VA Health Services Research Career Development Award and the Harold Amos Robert Wood Johnson Scholar Award. Dr. Ibrahim is also supported by a K24 Award (1K24AR055259-01) from the National Institutes of Musculoskeletal and Skin Disorders. The views expressed here are those of the authors and do not represent those of the Department of Veterans Affairs or the United States Government. The authors would like to thank project coordinator Margaret Kerr and members of the research staff: Elizabeth Flatley, Michael Hannon, Laura Johnson, Renee McDade, Matthew McShane, Rebecca Meiksin, Christine Schneider, Rebecca Siders, Lisa Stewart, and Sandra Truax. The authors would also like to thank Kim Hansen and Hilary Peterson for editorial input on this manuscript.

PY - 2010/9

Y1 - 2010/9

N2 - BACKGROUND: 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. OBJECTIVE: 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. DESIGN: Prospective, observational study. PARTICIPANTS: African-American (AA; n = 120) and white (n = 337) patients seeking treatment for knee or hip osteoarthritis in Veterans Affairs orthopedic clinics. MAIN MEASURES: 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. RESULTS: 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). CONCLUSIONS: 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.

AB - BACKGROUND: 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. OBJECTIVE: 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. DESIGN: Prospective, observational study. PARTICIPANTS: African-American (AA; n = 120) and white (n = 337) patients seeking treatment for knee or hip osteoarthritis in Veterans Affairs orthopedic clinics. MAIN MEASURES: 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. RESULTS: 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). CONCLUSIONS: 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.

KW - healthcare disparities

KW - orthopedic surgery

KW - osteoarthritis

KW - patient preference

KW - total joint replacement

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The effect of patient race on total joint replacement recommendations and utilization in the orthopedic setting

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