➢ Social determinants of health is considered an umbrella term that includes factors such as education level, income and occupation, social class, social status, race, ethnicity, and sex.➢ Socioeconomic status (SES) is a fundamental cause of health-care disparities and is a critical issue affecting all fields of medicine. In orthopaedic surgery, the quality of care provided, whether by surgical intervention or nonoperative treatment, is closely intertwined with social factors related to the SES of a patient.➢ SES is a known predictor of morbidity and mortality within different orthopaedic subspecialties, and modifiable factors contributing to low SES must be evaluated and optimized to reduce health-care disparities.➢ With the emergence of value-based health care and solutions seeking to improve outcomes and reduce cost, progress is being made toward reducing negative surgical outcome predictors associated with SES.➢ With the transition from fee-for-service models to alternate payment models based on practice-specific quality data, identification and risk adjustment based on SES variables will be critical to prevent patient exclusion, delay in care, and misrepresentation of a surgeon’s relative performance based on patient-reported outcomes.
ObjectiveCompeting risk analysis is a powerful assessment for cancer risk factors and covariates. This method can better elucidate insurance status and other social determinants of health covariates in oral cavity cancer treatment, survival, and disparities.Study DesignRetrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database.MethodsData regarding patient characteristics, clinical stage at diagnosis, treatment, and survival data for 20,271 patients diagnosed with oral cavity cancer was extracted from the SEER 18 Regs Research Data including Hurricane Katrina Impacted Louisiana Cases from 1973 to 2014. All statistical analyses were performed using SAS 9.5 (SAS Institute Inc., Cary, NC). The Fine‐Gray method for assessing impact, risk, and covariates was employed.ResultsMedicaid patients presented with later stage disease, larger tumor size, more distant metastases, and more lymph node involvement at diagnosis compared to insured patients. Medicaid patients were less likely to receive cancer‐directed surgery. Medicaid status was also associated with worse cancer‐specific survival (subhazard ratios 1.87, 95% confidence interval 1.72–2.04, P < .0001) after adjustment for all covariates.ConclusionThis is the first study examining specifically how Medicaid status and social determinants of health covariates impact oral cavity cancer treatment and outcomes and is the first using methods validated for complex covariates. Patients with Medicaid present with more extensive oral cavity disease burden are less likely to receive definitive therapy and have significantly worse overall survival than those with other forms of insurance. This better identifies disparities and the need for improving health literacy, specifically for the at‐risk Medicaid population, and can guide clinicians.Level of EvidenceNA Laryngoscope, 130:2160–2165, 2020
Introduction: The readability, reliability, and quality of online hip preservation-related patient education materials from the top 20 orthopaedic academic centers in the United States were evaluated. Methods: The patient educational materials were evaluated with the following assessment tools: Flesch-Kincaid (FK) readability test, Flesch Reading Ease formula, LIDA instrument, and DISCERN tool. Videos were assessed using the Patient Educational Video Assessment Tool (PEVAT), an author-developed scoring system. Results: A total of 121 educational items were reviewed. Median (interquartile range) or mean 6 SD of the FK level, Flesch Reading Ease, LIDA, and DISCERN scores were 11.00 (3.00), 47.32 6 12.14, 41.00 (6.00), and 64.00 (7.00), respectively. Higher ranking was correlated with higher FK (r = 20.21, P value = 0.034), higher DISCERN score (r = 20.39, P value , 0.005), and a lower PEVAT score (r = 0.61, P value = 0.034). The PEVAT score found that 83% of videos were classified as high quality.Discussion: An analysis of the hip preservation patient education text articles found low readability. Overall, high ranking was associated with poorer readability, higher quality text content, and lower quality video content. Video content was found to be predominantly of high quality. Improving the educational accessibility and effect of hip preservation-related topics may result in improved treatment outcomes. D eveloping technologies have revolutionized communication between health professionals and patients, completely changing patient education. With the exponential growth in web-based, health-related information, patients can access information readily; however, concerns exist regarding the relevance, readability, and accuracy of information. [1][2][3] Health literacy is a predictor of the overall patient health status,
Young drivers are overrepresented in motor-vehicle crashes compared to experienced drivers. Research shows that young drivers are generally clueless, not careless, failing to anticipate and mitigate latent hazards. There are several error-feedback training interventions that emphasize the teaching of latent hazard anticipation skills (e.g., risk awareness and perception training, RAPT) and a few that emphasize both the teaching of hazard anticipation and hazard mitigation skills (e.g., the driver simulation ACCEL). In the current study, a virtual reality, headset-based latent hazard anticipation and mitigation training program (V-RAPT) was developed on a head-mounted display (Oculus Rift). The headset provides the participant with a 100-degree wide field of view of six high-risk driving scenarios, the view changing appropriately as the participant rotates his or her head. Thirty-six young drivers were exposed to one of three training programs—V-RAPT, RAPT, and a placebo—and then evaluated on a driving simulator. Eye movement and vehicle data were collected throughout the simulator evaluation. The drives included the six scenarios used in training and four other scenarios dissimilar to the ones used in training, but previously validated as measures of hazard anticipation. The drivers trained on V-RAPT were found to anticipate a significantly greater proportion (86.25%) of latent hazards than the RAPT (62.36%) and placebo (30.97%) trained drivers. The V-RAPT trained drivers were also found to be better at mitigating potential threats. The virtual reality, headset-based training program holds out the promise of improving drivers’ ability to anticipate and mitigate latent threats and thereby reduce crashes.
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