Quality and Equity in Osteoarthritis: Understanding & Improving Treatment Use

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 DESCRIPTION (provided by applicant): Candidate Career Goals: Dr. Ernest R. Vina's long-term career goal is to promote equity for patients with rheumatic and musculoskeletal diseases through the development of interventions to eliminate racial disparities and improve outcomes for patients with these diseases. With his research and clinical experience in addressing the sources of racial disparities in the health and health care of patients with rheumatic diseases, Dr. Vina is well-suited to build a research career in this area. However, he will require additiona training and skills in order to address knowledge gaps by exploring patient characteristics and health beliefs that may contribute to disparities in the medical care of patients with osteoarthrits (OA). Dr. Vina's short-term career goals are 1) to develop the expertise required to study the reasons why race disparities in the use of different types of non-surgical OA treatment exist; and 2) to learn to develop an intervention and implement a clinical trial to reduce racial disparities n the use of various OA treatments. Research Background: OA is a highly prevalent and disabling disease. Racial disparities in the outcomes of OA patients have also been demonstrated, with African-Americans (AAs) carrying a greater burden than whites (WHs). In addition, AAs are also less likely to have history of use of various pharmacologic and non- pharmacologic therapies for OA. Sources of racial healthcare disparities in OA are only partially known. Research Aims: There are two main aims for this K23. The first is to examine the determinants of, and barriers to, the utilization of various OA treatments that contribute to disparities in the care of AAs and WHs. The second is to pilot-test the impact of an intervention designed to improve the utilization of effective, non- surgical OA treatments. Methods: To achieve the goals of the first aim, surveys of patients with knee or hip OA will be conducted. The survey will determine patient demographic information, psychosocial characteristics, disease severity, treatment history and health-related knowledge, beliefs and attitudes. The primary outcomes of interest will include utilization of various treatments, including exercises, topical medications, non-steroidal anti- inflammatory drugs and opioid agents. Hierarchical statistical modeling will be conducted to determine which patient-level variables may mediate racial disparities in the utilization of the various OA treatments. For the second aim, an existing educational tool will be chosen and enhanced with the goal of improving patient understanding of OA treatments and increasing the use of available OA therapies. Thereafter, this instrument will be pilot-tested to a relatively smal group of patients with knee or hip OA. The impact of this educational tool in improving the utilization of various OA therapies will be preliminarily determined.