The Effect of Patient Race on Total Joint Replacement Recommendations and Utilization in the Orthopedic Setting
The Effect of Patient Race on Total Joint Replacement Recommendations and Utilization in the Orthopedic Setting
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DOI：
10.1007/s11606-010-1399-5
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发表时间：
2010-09-01
影响因子：
5.7
通讯作者：
Ibrahim, Said A.
中科院分区：
文献类型：
--
作者：
Hausmann, Leslie R. M.;Mor, Maria;Ibrahim, Said A.
尚未探讨骨科环境中的治疗建议在多大程度上会导致晚期膝/髋骨关节炎使用全关节置换术 (TJR) 方面的既定种族差异。旨在检查与具有相似临床指征的白人患者相比，骨科医生是否不太可能向非裔美国患者推荐 TJR，以及在研究入组后六个月内接受 TJR 是否存在种族差异。前瞻性、观察性研究。非裔美国人 (AA; n = 120）和白人（n = 337）患者在退伍军人事务部骨科诊所寻求膝关节或髋关节骨关节炎的治疗。患者完成了评估可能影响骨关节炎治疗的社会人口统计和临床变量的调查。审查整形外科医生的记录以确定患者是否被推荐进行 TJR 以及他们是否在研究入组后 6 个月内接受了该手术。TJR 推荐率为 19.5%。 AA 获得 TJR 推荐的几率低于年龄和疾病严重程度相似的白人患者（OR = 0.46，95% CI = 0.26-0.83；P = 0.01）。然而，在调整患者对 TJR 的偏好后，这种差异并不显着（OR = 0.69，95% CI = 0.36-1.31，P = 0.25）。总体而言，10.3% 的患者在 6 个月内接受了 TJR。与年龄和疾病严重程度相似的白人患者相比，AA 患者发生 TJR 的可能性较小（OR = 0.41，95% CI = 0.16-1.05，P = 0.06），但在调整患者是否在初次就诊时接受手术建议后，这种差异有所减小（OR = 0.57，95% CI = 0.21-1.54，P = 0.27）。 在这项研究中，种族差异患者对 TJR 的偏好似乎是 TJR 建议中种族差异的基础，这导致了手术使用方面的种族差异。我们的研究结果表明，患者的治疗偏好在骨科 TJR 使用的种族差异中发挥着重要作用。
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.