The Effect of Patient Race on Total Joint Replacement Recommendations and Utilization in the Orthopedic Setting

Does a Patient-centered Educational Intervention Affect African-American Access to Knee Replacement? A Randomized Trial

“…In a study of patients with knee and hip OA at a VA orthopaedic clinic, patient preferences had the most substantial effect on receiving a recommendation for total joint replacement [13]. The decreased likelihood of black patients receiving a recommendation for joint replacement compared with white patients in that study was largely explained by the lower preference for joint replacement among blacks.…”

“…Studies also have shown that racial differences in patient preference contribute to racial variations in the use of total joint replacement [13,18,19,31]. How to best educate black patients about joint replacement as a viable treatment option, determine if undergoing the surgical procedure is consistent with their goals and values, and improve their access to surgical evaluation is unclear.…”

“…Response options ranged from ''definitely not willing'' to ''definitely willing'' in a fivecategory ordinal response scale. Willingness to undergo TKA has been shown to be the primary predictor of receiving a referral to an orthopaedic surgeon and actually receiving a TKA [13,14].…”

Editor's Spotlight/Take 5: Does a Patient-centered Educational Intervention Affect African-American Access to Knee Replacement? A Randomized Trial

“…A Randomized Trial,'' is an impressive multicenter study representing the collaborative efforts of investigators from the University of Pennsylvania, the Philadelphia Veterans Affairs Medical Center, and the University of Pittsburgh. This group, led by Said A. Ibrahim MD, MPH has made many contributions in the past on the topic of healthcare disparities [8,10,13]. Although black patients experience a greater burden of disease from osteoarthritis (OA) [9], they are much less likely to undergo knee replacement even when insurance status is not part of the picture [12].…”

Capsule Commentary on Kaplan et al., Reducing Racial/Ethnic Disparities in Diabetes: The Coached Care (R2D2C2) Project

“…O ne of the most troubling aspects of US medicine is the level of disparities in health and healthcare outcomes, [1][2][3] While previous work has generally focused on one or two potential contributors, the paper by Kaplan et al examines a myriad of patient, provider and system characteristics to explore the source of disparities in diabetes control among Mexican-Americans. 4 The differences in glycosylated hemoglobin seen between Vietnamese-Americans, non-Hispanic whites and MexicanAmericans were explained by differences in gender, age, duration of diabetes, education and income level and insurance status.…”