Patients' gender affected physicians' clinical decisions when presented with standardized patients but not for matching paper patients

Borkhoff, Cornelia M.; Hawker, Gillian; Kreder, Hans J.; Glazier, Richard H.; Mahomed, Nizar N.; Wright, James G.

doi:10.1016/j.jclinepi.2008.03.009

Cited by 37 publications

(32 citation statements)

References 60 publications

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“…First, our finding that Medicare payments were higher for several patient populations (women, older patients, and patients with greater comorbid illness) is not unexpected; our findings are likely a reflection of both higher complication rates for TKA in these subgroups and less social support necessitating greater reliance on home health services. [23][24][25][26] The implications of higher complication rates (and costs) for certain populations could have profound implications under a switch to bundled payments. To the extent that patients with similar sociodemographics (and risk for complications) cluster within hospitals, [27][28][29] certain hospitals could benefit by having a relatively low-risk TKA population and see profits from TKA soar; alternatively, other hospitals with a predominantly higher risk TKA population could see TKA as financially detrimental based upon geographic location and catchment area alone.…”

Section: Discussionmentioning

confidence: 99%

Bundled Payments for Elective Primary Total Knee Arthroplasty

Cram

Lü

2014

Geriatr Orthop Surg Rehabil

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Bundled payments have been proposed as a mechanism for restraining health care spending for total knee arthroplasty (TKA), but empirical data are limited. We used Medicare data to examine variation in payments for TKA during a window extending 30 days before to 90 days after TKA for 167 186 patients who underwent elective primary TKA in 2009. Mean Medicare payment was US$23 656. We found that 2.5% of patients incurred payments of >US$50 000 (0.2% >US$100 000). Payments were lower for men and for non-Hispanic whites but higher for patients with greater comorbidity. Episode-of-care payment for primary TKA varies substantially depending upon patient demographics and comorbidity. To the extent that similar patients tend to be clustered within hospitals, bundled payments could inadvertently cause financial harm to certain health systems while rewarding others.

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Section: Discussionmentioning

confidence: 99%

Bundled Payments for Elective Primary Total Knee Arthroplasty

Cram

Lü

2014

Geriatr Orthop Surg Rehabil

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“…This was most striking for AfricanAmerican women, who were less likely to be referred for cardiac catheterization than Caucasian men [29]. In a simulated study [3], orthopaedic physicians also have been implicated in preferentially advising TKA to men. Likewise, disparate rates of complications may confound outcomes across demographics: SooHoo et al [32] reported an association between African-Americans and thromboembolic complications and Hispanics and infectious complications.…”

Section: Discussionmentioning

confidence: 99%

Ethnic and Gender Differences in the Functional Disparities after Primary Total Knee Arthroplasty

Kamath

Horneff

Gaffney

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background The benefits of TKA have been well documented. Whether these benefits apply equally across gender and ethnic groups is unclear. Given the underuse of TKA among certain demographic groups, it is important to understand whether gender or ethnicity influence pain and function after TKA. Questions/purposes We determined (1) the influence of race, gender, and body mass index (BMI) on primary TKA functional scores and ROM before gender-specific implants; and (2) months).Results African-Americans had longer delays to presentation, higher BMI, and worse 2-year KSS. Women (all races) had higher BMI and worse preoperative flexion/arc ROM. African-American women had worse final ROM and had similar final gains in ROM (postoperative minus preoperative ROM) after controlling for confounders. Conclusions Gender and race affected functional KSS and ROM variables. The worse results experienced by AfricanAmerican women may be attributable to a longer delay to presentation. However, the scores and motion were high for all subgroups, and underuse of TKA in women and AfricanAmericans cannot be justified based on a perception of lesser functional gains. Level of Evidence Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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“…However, one study evaluating the role of utilization of TKA in female patients reported both primary care physicians and orthopaedic surgeons were less likely to recommend TKA for a standardized woman actor with moderate OA compared with a male actor with moderate OA and similar presentation [6]. In addition, another study not related to THA or TKA demonstrated physicians were less likely to recommend cardiac catheterization for African American male and female actors compared with non-Hispanic white actors presenting with identical history and findings [42].…”

Section: Patient and Provider Factors Contributing To Tja Utilizationmentioning

confidence: 99%