Current Concepts in Orthopaedic Care Disparities

Pandya, Nirav K.; Wustrack, Rosanna; Metz, Lionel N.; Ward, Derek

doi:10.5435/jaaos-d-17-00410

Cited by 88 publications

(69 citation statements)

References 43 publications

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“…[1][2][3] Despite increasing utilization of total shoulder arthroplasty (TSA) as an effective management of various shoulder pathologies, [4][5][6] the literature has demonstrated that enduring racial and gender disparities exist in joint replacement procedures. [7][8][9][10][11][12][13][14][15] An 18-year analysis of Medicare part A data showed that in 1991, the use of primary total knee arthroplasty (TKA) was 36% lower for African-Americans compared with Caucasians. 1 Though utilization more than doubled for both African-Americans and Caucasians by 2008, the usage of primary TKA was still 40% lower for African-Americans.…”

Section: Introductionmentioning

confidence: 99%

Racial and Gender Shoulder Arthroplasty Utilization Disparities of High- and Low-Volume Centers in New York State

Markes

Pareek

Mesfin

et al. 2021

Journal of Shoulder and Elbow Arthroplasty

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Introduction The literature has consistently demonstrated utilization disparities in joint replacement procedures, though no studies have evaluated disparities in total shoulder arthroplasty with regard to operative volume. Methods We queried the New York (NY) Statewide Planning and Research Cooperative System (SPARCS) database for 32 410 total shoulder arthroplasties performed between 2009 and 2017. Patients were identified using Clinical Classifications Software code 154 for Non-Hip/Knee Arthroplasty and All Patient Refined-Diagnosis Related Group code 322 for Shoulder. Racial groups included Hispanic, non-Hispanic white, non-Hispanic black, and Other. High-volume centers were facilities that performed 2 standard deviations above the mean annual procedures. Utilization rates were calculated by dividing total shoulder arthroplasties per group by the 2010 NY Census population of that group. The Fisher exact test was used to determine significance. Results Total shoulder arthroplasty utilization increased from 43/100 000 to 73/100 000, two-thirds of which was driven by an increase in white resident utilization. More White residents per 100 000 underwent shoulder arthroplasty than Black, Hispanic, and Other residents per 100 000 residents of their respective race. White residents were 90% more likely than Hispanic residents to undergo total shoulder arthroplasty at high-volume centers ( P = .04). There were no differences in utilization rate regarding operative volume comparing Black or Other residents to White residents. More females underwent total shoulder arthroplasty than males, though there was no difference in utilization rate regarding operative volume. Conclusion Though total shoulder arthroplasty utilization nearly doubled, disparities persisted across gender and minority groups particularly in Hispanic utilization as White residents were 90% more likely than Hispanic residents to undergo shoulder arthroplasty at high-volume centers.

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Section: Introductionmentioning

confidence: 99%

Racial and Gender Shoulder Arthroplasty Utilization Disparities of High- and Low-Volume Centers in New York State

Markes

Pareek

Mesfin

et al. 2021

Journal of Shoulder and Elbow Arthroplasty

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“…Many of these studies suggest that those without insurance or with Medicaid are less likely to use health care and are subject to differences in management and poorer outcomes when they do. 2,7,21,24,30,33 Looking specifically at orthoses, government-insured patients have been shown to experience delays up to 3 months in receiving prescribed orthoses compared to private-insured patients. 24 Our study suggests that these patients may not only experience delays but may not receive their orthoses at all.…”

Section: Discussionmentioning

confidence: 99%

“…While large, systematic change will be necessary, strategies can be employed by those working directly in patient care. Pandya et al 21 suggested informing primary care practices of their ability to see patients with limited insurance, limiting blanket refusal policies for government insurance, and educating office staff on how to most efficiently work with Medicare and Medicaid. In regards to race, at least 1 study has shown a low level of recognition of racial disparities in musculoskeletal care by orthopedic surgeons, suggesting a need to raise more awareness of such disparities within the field.…”

Section: Discussionmentioning

confidence: 99%

Race and Insurance Status Association With Receiving Orthopedic Surgeon-Prescribed Foot Orthoses

et al. 2021

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Background: This study looked at the effect of patient demographics, insurance status, education, and patient opinion on whether various orthotic footwear prescribed for a variety of diagnoses were received by the patient. The study also assessed the effect of the orthoses on relief of symptoms. Methods: Chart review documented patient demographics, diagnoses, and medical comorbidities. Eligible patients completed a survey either while in the clinic or by phone after their clinic visit. Results: Of the 382 patients prescribed orthoses, 235 (61.5%) received their orthoses; 186 (48.7%) filled out the survey. Race and whether or not the patient received the orthosis were found to be significant predictors of survey completion. Race, type of insurance, and amount of orthotic cost covered by insurance were significant predictors of whether or not patients received their prescribed orthoses. Type of orthosis, diabetes as a comorbidity, education, income, sex, and diagnosis were not significant predictors of whether the patient received the orthosis. Qualitative results from the survey revealed that among those receiving their orthoses, 87% experienced improvement in symptoms: 21% felt completely relieved, 66% felt better, 10% felt no different, and 3% felt worse. Conclusions: We found that white patients had almost 3 times the odds of receiving prescribed orthoses as black patients, even after controlling for type of insurance, suggesting race to be the primary driver of discrepancies, raising the question of what can be done to address these inequalities. While large, systematic change will be necessary, some strategies can be employed by those working directly in patient care, such as informing primary care practices of their ability to see patients with limited insurance, limiting blanket refusal policies for government insurance, and educating office staff on how to efficiently work with Medicare and Medicaid. Level of Evidence: Level III, comparative study.

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“… 6 , 40 , 42 Ultimately, these discordances in race between providers and patients negatively influence how treatments are administered and subsequent health outcomes across a number of fields. 3 , 9 , 12 , 20 , 21 , 31 , 49 For example, using national Medicare claims data, Skinner et al 43 showed that Black men and Asian women were significantly less likely to receive a clinically warranted total knee arthroplasty, even after controlling for income. Dy et al 11 studied the records of 197,290 patients in New York who underwent surgery for hip fracture and found that Black patients were at significantly greater risk for delayed surgery, reoperation, readmission, and 1-year in-hospital mortality than White patients.…”

mentioning

confidence: 99%

Current Perceptions of Diversity Among Head Team Physicians and Head Athletic Trainers: Results Across US Professional Sports Leagues

Wiggins

Agha

Diaz

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Discrepancies in race, ethnicity, and sex among health care providers and their patients have been shown to affect the patient-provider relationship as well as the quality of care. Currently, minority and female representation among orthopaedic surgeons remains low. Given the large proportion of minority athletes and their degree of public visibility, professional sports serves as an important arena within which to analyze the diversity of health care providers. Purpose: To describe and evaluate the current level of diversity of head team physicians (HTPs) and head athletic trainers (ATCs), primarily in terms of race and sex, within men’s professional sports leagues in the United States. Study Design: Cross-sectional study. Methods: Five major US professional sports leagues were evaluated: National Basketball Association, National Football League, National Hockey League, Major League Soccer, and Major League Baseball. Publicly available data were collected to identify the HTPs and head ATCs for each team within these leagues. Two independent observers analyzed photographs and names of these individuals to determine his or her perceived race and sex, with disagreements being resolved by a third independent observer. Other physician data collected included graduate degree(s), specialty, and number of years in practice. Kappa coefficients (κ) were employed to evaluate interobserver reliability. Chi-square, Fisher exact, and t tests were used for statistical comparisons across leagues. Results: The κ values for perceived race were 0.85 for HTPs and 0.89 for head ATCs, representing near-perfect interobserver agreement. Minorities comprised 15.5% of HTPs and 20.7% of ATCs ( P = .24). Women comprised 3.9% of HTPs and 1.3% of head ATCs ( P = .017). The majority of HTPs were orthopaedic surgeons with medical doctorates. Female HTPs had significantly fewer years in practice compared with male HTPs (15.0 ± 4.9 vs 23.1 ± 9.6; P = .04). Conclusion: The lead physicians and athletic training providers for men’s professional sports teams demonstrated low rates of minority and female representation, denoting a highly visible area for discussing the role of increased diversity in health care.

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Current Concepts in Orthopaedic Care Disparities

Cited by 88 publications

References 43 publications

Racial and Gender Shoulder Arthroplasty Utilization Disparities of High- and Low-Volume Centers in New York State

Racial and Gender Shoulder Arthroplasty Utilization Disparities of High- and Low-Volume Centers in New York State

Race and Insurance Status Association With Receiving Orthopedic Surgeon-Prescribed Foot Orthoses

Current Perceptions of Diversity Among Head Team Physicians and Head Athletic Trainers: Results Across US Professional Sports Leagues

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