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Troyer L, Khaleel M, Cook JL, Rucinski K. Addressing social determinants of health in orthopaedics: A systematic review of strategies and solutions. Knee 2024; 49:241-248. [PMID: 39043019 DOI: 10.1016/j.knee.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 06/06/2024] [Accepted: 07/04/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Barriers stemming from Social Determinants of Health (SDOH) are known to contribute to higher rates of complications, poor patient adherence to treatment plans, and suboptimal outcomes following orthopaedic care. While SDOH's impact has been characterized, interventions to address SDOH-related inequities in orthopaedics have not yet been optimized. PURPOSE The objective of the present systematic review was to identify and synthesize current peer-reviewed literature focused interventions to address SDOH-related inequities to develop optimal mitigation strategies that improve outcomes for orthopaedic patients. METHODS A systematic search of PubMed, OVID, and CINAHL identified articles that referenced SDOH and an intervention to address inequities. RESULTS After screening 419 studies, 19 met inclusion criteria. Studies commonly looked at the impact of insurance policy change on the rate of the population with active insurance and associated use of elective surgery. Nine studies found that policy changes generally increased the rate of insured patients, though inequities remained for younger and racial minority patients. The relative paucity of literature in conjunction with methodological differences among studies highlights the need for further development and validation of effective interventions to address SDOH-related inequities in orthopaedics. CONCLUSIONS Insurance expansion was the focus of the majority of included articles, finding that expansion is associated with higher rates of insured patients undergoing elective and emergent procedures, however, gaps remain for young patients and racial minorities. Further research is needed to determine effective healthcare team, healthcare system, and policy-level interventions that overcome SDOH-related barriers to optimal care and outcomes for orthopaedic patients. LEVEL OF EVIDENCE Level-II.
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Affiliation(s)
- Luke Troyer
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, United States
| | - Mubinah Khaleel
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, United States
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, United States; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, United States
| | - Kylee Rucinski
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, United States; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, United States.
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Mo K, Ikwuezunma I, Mun F, Ortiz-Babilonia C, Wang KY, Suresh KV, Uppal A, Sethi I, Mesfin A, Jain A. Racial Disparities in Spine Surgery: A Systematic Review. Clin Spine Surg 2023; 36:243-252. [PMID: 35994052 DOI: 10.1097/bsd.0000000000001383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/29/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Systematic Review. OBJECTIVES To synthesize previous studies evaluating racial disparities in spine surgery. METHODS We queried PubMed, Embase, Cochrane Library, and Web of Science for literature on racial disparities in spine surgery. Our review was constructed in accordance with Preferred Reporting Items and Meta-analyses guidelines and protocol. The main outcome measures were the occurrence of racial disparities in postoperative outcomes, mortality, surgical management, readmissions, and length of stay. RESULTS A total of 1753 publications were assessed. Twenty-two articles met inclusion criteria. Seventeen studies compared Whites (Ws) and African Americans (AAs) groups; 14 studies reported adverse outcomes for AAs. When compared with Ws, AA patients had higher odds of postoperative complications including mortality, cerebrospinal fluid leak, nervous system complications, bleeding, infection, in-hospital complications, adverse discharge disposition, and delay in diagnosis. Further, AAs were found to have increased odds of readmission and longer length of stay. Finally, AAs were found to have higher odds of nonoperative treatment for spinal cord injury, were more likely to undergo posterior approach in the treatment of cervical spondylotic myelopathy, and were less likely to receive cervical disk arthroplasty compared with Ws for similar indications. CONCLUSIONS This systematic review of spine literature found that when compared with W patients, AA patients had worse health outcomes. Further investigation of root causes of these racial disparities in spine surgery is warranted.
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Affiliation(s)
- Kevin Mo
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Ijezie Ikwuezunma
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Frederick Mun
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | | | - Kevin Y Wang
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Krishna V Suresh
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | | | | | - Addisu Mesfin
- Department of Orthopaedic Surgery, University of Rochester
| | - Amit Jain
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
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Salhany RJ, Genovese-Scullin D, Eversley-Danso JA, Mendez H, Rubinshteyn V, Lakhi N. Evaluating Inpatient Hospital Charges Associated With Trauma Service Patients Participating in an Accountable Care Organization. Health Serv Insights 2023; 16:11786329231166367. [PMID: 37066110 PMCID: PMC10090541 DOI: 10.1177/11786329231166367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 03/11/2023] [Indexed: 04/18/2023] Open
Abstract
Background The Medicare Accountable Care Organization (ACO) Program has created a vehicle for providers who practice cost containment and exceed quality for the Medicare population. The success of ACO's nationwide have been well documented. However, there is little research evaluating if there is a cost saving benefit in trauma care with respect to participating in an ACO. Thus, the primary objective of this study was to evaluate inpatient hospital charges associated with trauma service utilization of patients participating in the ACO compared to non-ACO patients. Methods This case-control retrospective study includes a comparison of inpatients charges of ACO patients (cases) and general trauma patients (controls) presenting to our trauma center in Staten Island, New York from January 1st, 2019 to December 31st, 2021. A 1:1 matching of case to control was performed based on age, sex, race, and injury severity score. Statistical analysis was performed with IBM SPSS, with P < .05 as significant. Results A total of 80 patients were included in the ACO cohort and 80 matched in the General Trauma cohort. Patient demographics were similar. Comorbidities were similar with the exception of a higher in incidence of hypertension (75.0% vs 47.5%, P < .001) and cardiac disease (35.0% vs 17.5%, P = .012) in the ACO cohort. Both the ACO and general trauma cohort had similar Injury Severity Scores, number of visits and lenght of stay. Both charge total ($76 148.93 vs $70 916.82, P = .630) receipt total ($15 080.26 vs $14 180, P = .662) charges were similar between ACO and General Trauma patients. Conclusion In spite of increased incidence of hypertension and cardiac disease in ACO trauma patients, mean Injury Severity Score, number of visits, length of hospital stay, ICU admission rate and charge total was similar compared to general trauma patients presenting to our Level 1 Adult Trauma Center.
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Affiliation(s)
- Richard J Salhany
- Department of Trauma Surgery, Richmond
University Medical Center, Staten Island, New York, NY, USA
| | - Daniel Genovese-Scullin
- Department of Trauma Surgery, Richmond
University Medical Center, Staten Island, New York, NY, USA
| | - Jasmin A Eversley-Danso
- Department of Trauma Surgery, Richmond
University Medical Center, Staten Island, New York, NY, USA
| | - Humroy Mendez
- Department of Trauma Surgery, Richmond
University Medical Center, Staten Island, New York, NY, USA
| | - Vladimir Rubinshteyn
- Department of Trauma Surgery, Richmond
University Medical Center, Staten Island, New York, NY, USA
| | - Nisha Lakhi
- Department of Trauma Surgery, Richmond
University Medical Center, Staten Island, New York, NY, USA
- New York Medical College, School of
Medicine, Valhalla, New York, NY, USA
- Nisha Lakhi, Department of Trauma Surgery,
New York Medical College, Richmond University Medical Center, 355 Bard Avenue,
Staten Island, NY 10310, USA.
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Cardinal T, Bonney PA, Strickland BA, Lechtholz-Zey E, Mendoza J, Pangal DJ, Liu J, Attenello F, Mack W, Giannotta S, Zada G. Disparities in the Surgical Treatment of Adult Spine Diseases: A Systematic Review. World Neurosurg 2021; 158:290-304.e1. [PMID: 34688939 DOI: 10.1016/j.wneu.2021.10.121] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Our goal was to systematically review the literature on racial/ethnic, insurance, and socioeconomic disparities in adult spine surgery in the United States and analyze potential areas for improvement. METHODS We conducted a database search of literature published between January 1990 and July 2020 using PRISMA guidelines for all studies investigating a disparity in any aspect of adult spine surgery care analyzed based on race/ethnicity, insurance status/payer, or socioeconomic status (SES). RESULTS Of 2679 articles identified through database searching, 775 were identified for full-text independent review by 3 authors, from which a final list of 60 studies were analyzed. Forty-three studies analyzed disparities based on patient race/ethnicity, 32 based on insurance status, and 8 based on SES. Five studies assessed disparities in access to care, 15 examined surgical treatment, 35 investigated in-hospital outcomes, and 25 explored after-discharge outcomes. Minority patients were less likely to undergo surgery but more likely to receive surgery from a low-volume provider and experience postoperative complications. White and privately insured patients generally had shorter hospital length of stay, were more likely to undergo favorable/routine discharge, and had lower rates of in-hospital mortality. After discharge, white patients reported better outcomes than did black patients. Thirty-three studies (55%) reported no disparities within at least 1 examined metric. CONCLUSIONS This comprehensive systematic review underscores ongoing potential for health care disparities among adult patients in spinal surgery. We show a need for continued efforts to promote equity and cultural competency within neurologic surgery.
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Affiliation(s)
- Tyler Cardinal
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA.
| | - Phillip A Bonney
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Ben A Strickland
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Elizabeth Lechtholz-Zey
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Jesse Mendoza
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Dhiraj J Pangal
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - John Liu
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Frank Attenello
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - William Mack
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Steven Giannotta
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Gabriel Zada
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
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Tummalapalli SL, Ibrahim SA. Alternative Payment Models and Opportunities to Address Disparities in Kidney Disease. Am J Kidney Dis 2020; 77:769-772. [PMID: 33098924 PMCID: PMC7577223 DOI: 10.1053/j.ajkd.2020.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/02/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Sri Lekha Tummalapalli
- Division of Healthcare Delivery Science & Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY.
| | - Said A Ibrahim
- Division of Healthcare Delivery Science & Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
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