ETHNIC DISPARITY IN THE USE OF JOINT ARTHROPLASTY

描述(由申请人提供)： 全关节置换术治疗骨性关节炎是20世纪末的医学奇迹之一。不幸的是，所看到的好处在少数族裔中并不平均分配。研究人员的长期目标是了解非裔美国人和白人在关节置换术使用方面存在差异的原因。这项为期五年的前瞻性队列研究的目的是确定关节置换率的种族差异是否可以用以下因素来解释：a)关节置换术转诊至骨科医生的适当性(即，共病、年龄、症状严重程度和医疗管理的充分性)的差异，和/或b)对骨关节炎的健康信念和关节置换术后的期望的差异。由于转介给整形外科医生是向骨关节炎患者提供全关节置换术的主要途径，他们计划在威沙德纪念医院(县医院)和罗德布什退伍军人管理医疗中心(VAMC)的初级保健诊所招募患者。他们将在两年的随访期内从患者的几个时间点收集相关的社会文化和临床变量。转诊状况(无论是否转诊)是他们感兴趣的主要结果衡量标准。由于转诊决定涉及患者和初级保健医生(PCP)，他们还将调查(由患者确定的)PCP关于关节置换术的一般态度和知识。作为拟议调查的结果，他们希望确定与转诊至骨科医生相关的因素，并确定这些因素是否可以解释关节置换术转诊率的种族差异。这项拟议的研究意义重大，因为在患者-初级保健计划水平上确定的可修改因素可能适用于教育或行为干预，从而消除种族差异。

DESCRIPTION (provided by applicant): Total joint arthroplasty for osteoarthritis (OA) is one of the medical miracles of the late 20th century. Unfortunately, the benefits seen are not equally distributed among ethnic minorities. The investigators' long-term goal is to understand the reasons behind the disparity in the use of joint arthroplasty between African-Americans and Whites. The objective of this five-year prospective cohort study is to determine whether ethnic variations in rates of joint arthroplasty can be explained by: a) Differences in the appropriateness of referral to the orthopedic surgeon (i.e., comorbidity, age, symptom severity, and adequacy of medical management) for joint arthroplasty, and/or; b) Differences in health beliefs about OA, and expectations following joint arthroplasty. Because referral to the orthopedic surgeon is the main avenue by which use of total joint arthroplasty is made available to patients with OA, they plan to recruit patients in the Primary Care Clinics of Wishard Memorial Hospital (County Hospital) and the Roudebush Veterans Administration Medical Center (VAMC). They will collect pertinent socio-cultural and clinical variables from patients at several time points during a two-year follow-up period. Referral status (whether referred or not referred) is their major outcome measure of interest. Because the decision to refer involves both the patient and the primary care physician (PCP), they will also survey the PCPs (as identified by their patients) concerning general attitude and knowledge about joint arthroplasty. As an outcome of the proposed investigation, they expect to identify factors associated with referral to an orthopedic surgeon and to determine if they explain the ethnic difference in referral rates for joint arthroplasty. The proposed study is significant because modifiable factors identified at the patient-PCP level may be amenable to educational or behavioral intervention which could eradicate ethnic disparity.