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Brusco NK, Ekegren CL, Morris ME, Hill KD, Lee AL, Somerville L, Lannin NA, Abdelmotaleb R, Callaway L, Whittaker SL, Taylor NF. Outcomes of the My Therapy self-management program in people admitted for rehabilitation: A stepped wedge cluster randomized clinical trial. Ann Phys Rehabil Med 2024; 67:101867. [PMID: 39173328 DOI: 10.1016/j.rehab.2024.101867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/07/2024] [Accepted: 05/19/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Self-management programs can increase the time spent on prescribed therapeutic exercises and activities in rehabilitation inpatients, which has been associated with better functional outcomes and shorter hospital stays. OBJECTIVES To determine whether implementation of a self-management program ('My Therapy') improves functional independence relative to routine care in people admitted for physical rehabilitation. METHODS This stepped wedge, cluster randomized trial was conducted over 54 weeks (9 periods of 6-week duration, April 2021 - April 2022) across 9 clusters (general rehabilitation wards) within 4 hospitals (Victoria, Australia). We included all adults (≥18 years) admitted for rehabilitation to participating wards. The intervention included routine care plus 'My Therapy', comprising a sub-set of exercises and activities from supervised sessions which could be performed safely, without supervision or assistance. The primary outcomes were the proportion of participants achieving a minimal clinically important difference (MCID) in the Functional Independence Measure, (FIM™) and change in total FIM™ score from admission to discharge. RESULTS 2550 participants (62 % women) were recruited (control: n = 1458, intervention: n = 1092), with mean (SD) age 77 (13) years and 37 % orthopedic diagnosis. Under intervention conditions, participants reported a mean (SD) of 29 (21) minutes/day of self-directed therapy, compared to 4 (SD 14) minutes/day, under control conditions. There was no evidence of a difference between control and intervention conditions in the odds of achieving an MCID in FIM™ (adjusted odds ratio 0.93, 95 % CI 0.65 to 1.31), or in the change in FIM™ score (adjusted mean difference: -0.27 units, 95 % CI -2.67 to 2.13). CONCLUSIONS My Therapy was delivered safely to a large, diverse sample of participants admitted for rehabilitation, with an increase in daily rehabilitation dosage. However, given the lack of difference in functional improvement with participation in My Therapy, self-management programs may need to be supplemented with other strategies to improve function in people admitted for rehabilitation. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12621000313831), https://www.anzctr.org.au/.
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Affiliation(s)
- Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC 3199 Australia.
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC 3199 Australia
| | - Meg E Morris
- Academic and Research Collaborative in Health (ARCH), La Trobe University, Bundoora, VIC 3086 Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC 3199 Australia
| | - Annemarie L Lee
- Department of Physiotherapy, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC 3199 Australia
| | | | - Natasha A Lannin
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC 3004 Australia; Alfred Health, Melbourne, VIC 3004 Australia
| | | | - Libby Callaway
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC 3199 Australia; Occupational Therapy Department, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC 3199 Australia
| | - Sara L Whittaker
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC 3199 Australia
| | - Nicholas F Taylor
- Academic and Research Collaborative in Health (ARCH), La Trobe University, Bundoora, VIC 3086 Australia; Eastern Health, 2/5 Arnold Street, Box Hill, VIC 3128 Australia
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Kim H, Hart KD, Senders A, Schabel K, Ibrahim SA. Elective Joint Replacement Among Medicaid Beneficiaries: Utilization and Postoperative Adverse Events by Racial and Ethnic Groups. Popul Health Manag 2024; 27:128-136. [PMID: 38442304 DOI: 10.1089/pop.2023.0310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
Hip and knee replacement have been marked by racial and ethnic disparities in both utilization and postoperative adverse events among Medicare beneficiaries, but limited knowledge exists regarding racial and ethnic differences in joint replacement care among Medicaid beneficiaries. To close this gap, this study used Medicaid claims in 2018 and described racial and ethnic differences in the utilization and postoperative adverse events of elective joint replacements among Medicaid beneficiaries. Among the 2,260,272 Medicaid beneficiaries, 5987 had an elective joint replacement in 2018. Asian (0.05%, 95% confidence interval [CI]: 0.03%-0.07%) and Hispanic beneficiaries (0.12%, 95% CI: 0.07%-0.18%) received joint replacements less frequently than American Indian and Alaska Native (0.41%, 95% CI: 0.27%-0.55%), Black (0.33%, 95% CI: 0.19%-0.48%), and White (0.37%, 95% CI: 0.25%-0.50%) beneficiaries. Black patients demonstrated the highest probability of 90-day emergency department visits (34.8%, 95% CI: 32.7%-37.0%) among all racial and ethnic groups and a higher probability of 90-day readmission (8.0%, 95% CI: 6.9%-9.0%) than Asian (3.4%, 95% CI: 0.7%-6.0%) and Hispanic patients (4.4%, 95% CI: 3.4%-5.3%). These findings indicate evident disparities in postoperative adverse events across racial and ethnic groups, with Black patients demonstrating the highest probability of 90-day emergency department visits. This study represents an initial exploration of the racial and ethnic differences in joint replacement care among Medicaid beneficiaries and lay the groundwork for further investigation into contributing factors of the observed disparities.
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Affiliation(s)
- Hyunjee Kim
- Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, Oregon, USA
| | - Kyle D Hart
- Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, Oregon, USA
| | - Angela Senders
- Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, Oregon, USA
| | - Kathryn Schabel
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon, USA
| | - Said A Ibrahim
- Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, USA
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Bergstein VE, O'Sullivan LR, Levy KH, Vulcano E, Aiyer AA. Racial Disparities in 30-day Readmission After Orthopaedic Surgery: A 5-year National Surgical Quality Improvement Program Database Analysis. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00004. [PMID: 38437055 PMCID: PMC10906581 DOI: 10.5435/jaaosglobal-d-24-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/17/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Readmission rate after surgery is an important outcome measure in revealing disparities. This study aimed to examine how 30-day readmission rates and causes of readmission differ by race and specific injury areas within orthopaedic surgery. METHODS The American College of Surgeon-National Surgical Quality Improvement Program database was queried for orthopaedic procedures from 2015 to 2019. Patients were stratified by self-reported race. Procedures were stratified using current procedural terminology codes corresponding to given injury areas. Multiple logistic regression was done to evaluate associations between race and all-cause readmission risk, and risk of readmission due to specific causes. RESULTS Of 780,043 orthopaedic patients, the overall 30-day readmission rate was 4.18%. Black and Asian patients were at greater (OR = 1.18, P < 0.01) and lesser (OR = 0.76, P < 0.01) risk for readmission than White patients, respectively. Black patients were more likely to be readmitted for deep surgical site infection (OR = 1.25, P = 0.03), PE (OR = 1.64, P < 0.01), or wound disruption (OR = 1.45, P < 0.01). For all races, all-cause readmission was highest after spine procedures and lowest after hand/wrist procedures. CONCLUSIONS Black patients were at greater risk for overall, spine, shoulder/elbow, hand/wrist, and hip/knee all-cause readmission. Asian patients were at lower risk for overall, spine, hand/wrist, and hip/knee surgery all-cause readmission. Our findings can identify complications that should be more carefully monitored in certain patient populations.
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Affiliation(s)
- Victoria E. Bergstein
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD (Ms. Bergstein, Ms. O’Sullivan, Dr. Aiyer); the Sophie Davis Biomedical Education Program, CUNY School of Medicine, New York, NY (Mr. Levy), and the Columbia University Orthopedics at Mount Sinai Medical Center, Miami Beach, FL (Dr. Vulcano)
| | - Lucy R. O'Sullivan
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD (Ms. Bergstein, Ms. O’Sullivan, Dr. Aiyer); the Sophie Davis Biomedical Education Program, CUNY School of Medicine, New York, NY (Mr. Levy), and the Columbia University Orthopedics at Mount Sinai Medical Center, Miami Beach, FL (Dr. Vulcano)
| | - Kenneth H. Levy
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD (Ms. Bergstein, Ms. O’Sullivan, Dr. Aiyer); the Sophie Davis Biomedical Education Program, CUNY School of Medicine, New York, NY (Mr. Levy), and the Columbia University Orthopedics at Mount Sinai Medical Center, Miami Beach, FL (Dr. Vulcano)
| | - Ettore Vulcano
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD (Ms. Bergstein, Ms. O’Sullivan, Dr. Aiyer); the Sophie Davis Biomedical Education Program, CUNY School of Medicine, New York, NY (Mr. Levy), and the Columbia University Orthopedics at Mount Sinai Medical Center, Miami Beach, FL (Dr. Vulcano)
| | - Amiethab A. Aiyer
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD (Ms. Bergstein, Ms. O’Sullivan, Dr. Aiyer); the Sophie Davis Biomedical Education Program, CUNY School of Medicine, New York, NY (Mr. Levy), and the Columbia University Orthopedics at Mount Sinai Medical Center, Miami Beach, FL (Dr. Vulcano)
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Silvestre J, Walker JJ, LaPorte DM, Nelson CL. Women Are Underrepresented Among Principal Investigators of Hip and Knee Arthroplasty Clinical Trials in the United States. J Bone Joint Surg Am 2023; 105:1734-1739. [PMID: 37315108 DOI: 10.2106/jbjs.23.00205] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Leadership of clinical trials confers national recognition and promotes academic advancement. We hypothesized that women would be underrepresented among principal investigators (PIs) of hip and knee arthroplasty clinical trials in the United States. METHODS A query of hip and knee arthroplasty clinical trials from 2015 to 2021 was performed on ClinicalTrials.gov. Clinical trials were included if they involved a U.S.-based orthopaedic-surgeon PI. We analyzed the sex representation of arthroplasty PIs among junior-level (assistant professor) and senior-level (associate or full professor) faculty. Participation-to-prevalence ratios (PPRs) were calculated by comparing the sex representation among arthroplasty PIs with that among academic arthroplasty faculty at institutions conducting hip and knee arthroplasty clinical trials. A PPR of <0.8 indicated underrepresentation and a PPR of >1.2 indicated overrepresentation. RESULTS A total of 157 clinical trials involving 192 arthroplasty PIs were included. Of these PIs, only 2 (1.0%) were women. PIs were mostly funded by academic institutions (66%) and industry (33%). U.S. federal sources funded a minority (1%) of PIs. Of the 243 male arthroplasty faculty who were eligible, 190 men (78.2%) served as PIs. In contrast, of the 17 female arthroplasty faculty who were eligible, only 2 women (11.8%) served as PIs (p < 0.001). Across the entire cohort of arthroplasty PIs, women were underrepresented (PPR = 0.16), whereas men were equitably represented (PPR = 1.06). Women were underrepresented at the assistant professor (PPR = 0.0), associate professor (PPR = 0.52), and full professor (PPR = 0.58) levels. CONCLUSIONS Women were underrepresented among PIs of hip and knee arthroplasty clinical trials, which may lead to disparities in academic promotion and advancement. More research is needed to understand the potential barriers to female leadership of clinical trials. Greater awareness and engagement are needed to create sex equity in clinical trial leadership for hip and knee arthroplasty research. CLINICAL RELEVANCE The underrepresentation of women among arthroplasty PIs may lead to fewer options in surgical providers for patients and may limit access to musculoskeletal care for certain patient populations. A diverse arthroplasty workforce can promote attention to issues that disproportionately affect historically underrepresented and vulnerable patient populations.
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Affiliation(s)
- Jason Silvestre
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Dawn M LaPorte
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles L Nelson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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5
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Gender and outcomes in total joint arthroplasty: a systematic review on healthcare disparities in the United States. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Alvarez PM, McKeon JF, Spitzer AI, Krueger CA, Pigott M, Li M, Vajapey SP. Race, Utilization, and Outcomes in Total Hip and Knee Arthroplasty: A Systematic Review on Health-Care Disparities. JBJS Rev 2022; 10:01874474-202203000-00003. [PMID: 35231001 DOI: 10.2106/jbjs.rvw.21.00161] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Previous studies have shown that utilization and outcomes of total joint arthroplasty (TJA) are not equivalent across different patient cohorts. This systematic review was designed to evaluate the currently available evidence regarding the effect that patient race has, if any, on utilization and outcomes of lower-extremity arthroplasty in the United States. METHODS A literature search of the MEDLINE database was performed using keywords such as "disparities," "arthroplasty," "race," "joint replacement," "hip," "knee," "inequities," "inequalities," "health," and "outcomes" in all possible combinations. All English-language studies with a level of evidence of I through IV published over the last 20 years were considered for inclusion. Quantitative and qualitative analyses were performed on the collected data. RESULTS A total of 82 articles were included. There was a significantly lower utilization rate of lower-extremity TJA among Black, Hispanic, and Asian patients compared with White patients (p < 0.05). Black and Hispanic patients had lower expectations regarding postoperative outcomes and their ability to participate in various activities after surgery, and they were less likely than White patients to be familiar with the arthroplasty procedure prior to presentation to the orthopaedic surgeon (p < 0.05). Black patients had increased risks of major complications, readmissions, revisions, and discharge to institutional care after TJA compared with White patients (p < 0.05). Hispanic patients had increased risks of complications (p < 0.05) and readmissions (p < 0.0001) after TJA compared with White patients. Black and Hispanic patients reached arthroplasty with poorer preoperative functional status, and all minority patients were more likely to undergo TJA at low-quality, low-volume hospitals compared with White patients (p < 0.05). CONCLUSIONS This systematic review shows that lower-extremity arthroplasty utilization differs by racial/ethnic group, and that some of these differences may be partly explained by patient expectations, preferences, and cultural differences. This study also shows that outcomes after lower-extremity arthroplasty differ vastly by racial/ethnic group, and that some of these differences may be driven by differences in preoperative functional status and unequal access to care. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Paul M Alvarez
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - John F McKeon
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Andrew I Spitzer
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Chad A Krueger
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Matthew Pigott
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Mengnai Li
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sravya P Vajapey
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Souesme G, Voyer M, Gagnon É, Terreau P, Fournier-St-Amand G, Lacroix N, Gravel K, Vaillant MC, Gagné MÈ, Ouellet MC. Barriers and facilitators linked to discharge destination following inpatient rehabilitation after traumatic brain injury in older adults: a qualitative study. Disabil Rehabil 2021; 44:4738-4749. [PMID: 34126821 DOI: 10.1080/09638288.2021.1919212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To identify facilitators and barriers associated with returning home for older adults having received inpatient rehabilitation after traumatic brain injury (TBI). METHODS A qualitative design was used. Five older patients with TBI and four family caregivers were interviewed and six healthcare professionals participated in a focus group. RESULTS Main facilitators to returning home highlighted by all participants were: (1) Patient's adequate health condition and functional status, (2) Access to health and other services at home, (3) Availability of help from a family caregiver. Conversely, if one of these factors was not met, it represented a barrier. Other facilitators identified were (4) Attachment to one's home, (5) Feeling of commitment toward a loved one, (6) Having the possibility of going through a transitional phase, (7) United front between the patient and the family caregiver towards a return home. Additional barriers to returning home included: (8) Incongruent perspectives, and (9) Unclear knowledge about available health and other services at home. CONCLUSION The results of this study could be translated into a practical tool to guide patients, families and professionals in the decision about returning home or exploring an alternative option after inpatient rehabilitation for TBI in older adults.IMPLICATIONS FOR REHABILITATIONWhen orienting an older patient home or to an alternative living environment after a traumatic brain injury (TBI), the perspective of rehabilitation professionals can differ from that of patients and caregivers.Professionals tend to emphasize security, whereas patients and caregivers' focus on the well-being associated with home and on the importance of being with their loved one.Integrating the views, values and wishes of older patients with TBI and their caregivers will support a shared decision-making approach for orientation after rehabilitation.
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Affiliation(s)
- Guillaume Souesme
- Interdisciplinary Centre for Research in Rehabilitation and Social Integration, Québec, Canada.,School of Psychology, Laval University, Québec, Canada
| | - Manon Voyer
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale- Site, Institut de réadaptation en déficience physique de Québec, Canada
| | - Éric Gagnon
- Centre de Recherche sur les Soins et les Services de Première Ligne, Québec, Canada.,Sociology Department, Laval University, Québec, Canada
| | - Paule Terreau
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale- Site, Institut de réadaptation en déficience physique de Québec, Canada
| | - Geneviève Fournier-St-Amand
- Interdisciplinary Centre for Research in Rehabilitation and Social Integration, Québec, Canada.,School of Psychology, Laval University, Québec, Canada
| | - Nadine Lacroix
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale- Site, Institut de réadaptation en déficience physique de Québec, Canada
| | - Kristina Gravel
- Interdisciplinary Centre for Research in Rehabilitation and Social Integration, Québec, Canada.,School of Psychology, Laval University, Québec, Canada
| | - Marie-Claude Vaillant
- Interdisciplinary Centre for Research in Rehabilitation and Social Integration, Québec, Canada.,School of Psychology, Laval University, Québec, Canada
| | - Marie-Ève Gagné
- Interdisciplinary Centre for Research in Rehabilitation and Social Integration, Québec, Canada.,School of Psychology, Laval University, Québec, Canada
| | - Marie-Christine Ouellet
- Interdisciplinary Centre for Research in Rehabilitation and Social Integration, Québec, Canada.,School of Psychology, Laval University, Québec, Canada
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8
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Does racial background influence outcomes following total joint arthroplasty? J Clin Orthop Trauma 2021; 19:139-146. [PMID: 34099973 PMCID: PMC8167263 DOI: 10.1016/j.jcot.2021.05.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 05/16/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The purpose of this study is to assess whether racial differences influence patient-reported outcome measures (PROMs) following primary total hip (THA) and knee (TKA) arthroplasty. METHODS We retrospectively reviewed patients who underwent primary THA or TKA from 2016 to 2020 with available PROMs. Both THA and TKA patients were separated into three groups based on their ethnicity: Caucasian, African-American, and other races. Patient demographics, clinical data, and PROMs at various time-periods were collected and compared. Demographic differences were assessed using chi-square and ANOVA. Univariate ANCOVA was utilized to compare outcomes and PROMs while accounting for demographic differences. RESULTS This study included 1999 THA patients and 1375 TKA patients. In the THA cohort, 1636 (82%) were Caucasian, 177 (9%) were African-American, and 186 (9%) were of other races. In the TKA cohort, 864 (63%) were Caucasian, 236 (17%) were African-American, and 275 (20%) were of other races. Surgical-time significantly differed between the groups that underwent THA (88.4vs.100.5vs.96.1; p < 0.001) with African-Americans requiring the longest operative time. Length-of-stay significantly differed in both THA (1.5vs.1.9vs.1.8; p < 0.001) and TKA (2.1vs.2.5vs.2.3; p < 0.001) cohorts, with African-Americans having the longest stay. Caucasians reported significantly higher PROM scores compared to non-Caucasians in both cohorts. All-cause emergency-department (ED) visits, 90-day postoperative events (readmissions&revisions), and discharge-disposition did not statistically differ in both cohorts. CONCLUSION Non-Caucasian patients demonstrated lower PROM scores when compared to Caucasian patients following TJA although the differences may not be clinically relevant. LOS was significantly longer for African-Americans in both THA and TKA cohorts. Further investigation identifying racial disparity interventions is warranted. LEVEL OF EVIDENCE Prognostic Level III.
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9
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Racial and socioeconomic disparities among patients undergoing hip arthroplasty: a New York State population analysis. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000001015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Tachi T, Otsubo M, Toyoshima M, Katsuno H, Ueno A, Noguchi Y, Aoyama S, Yasuda M, Mizui T, Goto C, Teramachi H. What activities of daily living at discharge affect the discharge destination of patients in an acute-care hospital in Japan: A retrospective factor analysis. Int J Health Plann Manage 2021; 36:1326-1337. [PMID: 33893659 DOI: 10.1002/hpm.3183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 04/12/2021] [Indexed: 11/10/2022] Open
Abstract
It is important to clarify the influence of activities of daily living (ADL) at discharge on the discharge destination of hospitalised patients. The Functional Independence Measure (FIM) is a widely used ADL assessment scale. In this retrospective study, we aimed to identify what ADL based on FIM at discharge affect the discharge destination of hospitalised patients in an acute-care hospital, in addition to how nutritional status and the number of drugs used, as well as types of disease, affect discharge-to-home. We surveyed age, sex, disease type, length of hospital stay, discharge destination, FIM score at discharge, serum albumin level, and the number of continued drugs in hospitalised patients who underwent rehabilitation in Gifu Municipal Hospital (Gifu, Japan) between January 2014 and December 2014. Multiple logistic regression analysis was performed with discharge to home as a dependent variable and age, sex, disease, FIM score and polypharmacy as independent variables. Multiple logistic regression analysis indicated that a significantly high percentage of discharged-to-home patients were associated with 'self-care' (≥33 points; OR: 2.03), 'sphincter control' (≥14 points; OR: 1.49), 'transfers' (≥13 points; OR: 1.94), and 'locomotion' (≥7 points; OR: 3.55), among others. High FIM sub-scale scores at discharge for self-care, sphincter control, transfers, and locomotion were clarified as factors associated with discharge-to-home. These findings of the association of ADL based on FIM and discharge destination would be useful in deciding discharge destinations for patients in an acute-phase hospital.
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Affiliation(s)
- Tomoya Tachi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan.,Department of Pharmacy, Gifu Municipal Hospital, Gifu, Japan
| | - Manami Otsubo
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Manabu Toyoshima
- Department of Pharmacy, Tomei Atsugi Hospital, Atsugi, Kanagawa, Japan
| | - Hayato Katsuno
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Anri Ueno
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Yoshihiro Noguchi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Satoshi Aoyama
- Department of Pharmacy, Gifu Municipal Hospital, Gifu, Japan
| | - Masahiro Yasuda
- Department of Pharmacy, Gifu Municipal Hospital, Gifu, Japan
| | - Takashi Mizui
- Department of Pharmacy, Gifu Municipal Hospital, Gifu, Japan
| | - Chitoshi Goto
- Department of Pharmacy, Gifu Municipal Hospital, Gifu, Japan
| | - Hitomi Teramachi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan.,Laboratory of Community Health Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
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Kim H, Meath THA, Tran FW, Quiñones AR, McConnell KJ, Ibrahim SA. Association of Medicare Mandatory Bundled Payment System for Hip and Knee Joint Replacement With Racial/Ethnic Difference in Joint Replacement Care. JAMA Netw Open 2020; 3:e2014475. [PMID: 32960277 PMCID: PMC7509636 DOI: 10.1001/jamanetworkopen.2020.14475] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/10/2020] [Indexed: 01/08/2023] Open
Abstract
Importance There are marked racial/ethnic differences in hip and knee joint replacement care as well as concerns that value-based payments may exacerbate existing racial/ethnic disparities in care. Objective To examine changes in joint replacement care associated with Medicare's Comprehensive Care for Joint Replacement (CJR) model among White, Black, and Hispanic patients. Design, Setting, and Participants Retrospective cohort study of Medicare claims from 2013 through 2017 among White, Black, and Hispanic patients undergoing joint replacement in 67 treatment (selected for CJR participation) and 103 control metropolitan statistical areas. Exposures The CJR model holds hospitals accountable for spending and quality of joint replacement care during care episodes (index hospitalization through 90 days after discharge). Main Outcomes and Measures The primary outcomes were spending, discharge to institutional postacute care, and readmission during care episodes. Results Among 688 346 patients, 442 163 (64.2%) were women, and 87 286 (12.7%) were 85 years or older. Under CJR, spending decreased by $439 for White patients (95% CI, -$718 to -$161; from pre-CJR spending in treatment metropolitan statistical areas of $25 264) but did not change for Black patients and Hispanic patients. Discharges to institutional postacute care decreased for all groups (-2.5 percentage points; 95% CI, -4.7 to -0.4, from pre-CJR risk of 46.2% for White patients; -6.0 percentage points; 95% CI, -9.8 to -2.2, from pre-CJR risk of 59.5% for Black patients; and -4.3 percentage points; 95% CI, -7.6 to -1.0, from pre-CJR risk of 54.3% for Hispanic patients). Readmission risk decreased for Black patients by 3.1 percentage points (95% CI, -5.9 to -0.4, from pre-CJR risk of 21.8%) and did not change for White patients and Hispanic patients. Under CJR, Black-White differences in discharges to institutional postacute care decreased by 3.4 percentage points (95% CI, -6.4 to -0.5, from the pre-CJR Black-White difference of 13.3 percentage points). No evidence was found demonstrating that Black-White differences changed for other outcomes or that Hispanic-White differences changed for any outcomes under CJR. Conclusions and Relevance In this cohort study of patients receiving joint replacements, CJR was associated with decreased readmissions for Black patients. Furthermore, Black patients experienced a greater decrease in discharges to institutional postacute care relative to White patients, representing relative improvements despite concerns that value-based payment models may exacerbate existing disparities. Nonetheless, differences between White and Black patients in joint replacement care still persisted even after these changes.
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Affiliation(s)
- Hyunjee Kim
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland
| | - Thomas H. A. Meath
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland
| | - Felix W. Tran
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland
| | - Ana R. Quiñones
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - K. John McConnell
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland
| | - Said A. Ibrahim
- Department of Population Health Sciences, Weill Cornell Medicine/New York Presbyterian Health System, New York, New York
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12
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Adejumo AC, Samuel GO, Adegbala OM, Adejumo KL, Ojelabi O, Akanbi O, Ogundipe OA, Pani L. Prevalence, trends, outcomes, and disparities in hospitalizations for nonalcoholic fatty liver disease in the United States. Ann Gastroenterol 2019; 32:504-513. [PMID: 31474798 PMCID: PMC6686099 DOI: 10.20524/aog.2019.0402] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/24/2019] [Indexed: 02/06/2023] Open
Abstract
Background As the frequency of nonalcoholic fatty liver disease (NAFLD) continues to rise in the United States (US) community, more patients are hospitalized with NAFLD. However, data on the prevalence and outcomes of hospitalizations with NAFLD are lacking. We investigated the prevalence, trends and outcomes of NAFLD hospitalizations in the US. Methods Hospitalizations with NAFLD were identified in the National Inpatient Sample (2007-2014) by their ICD-9-CM codes, and the prevalence and trends over an 8-year period were calculated among different demographic groups. After excluding other causes of liver disease among the NAFLD cohorts (n=210,660), the impact of sex, race and region on outcomes (mortality, discharge disposition, length of stay [LOS], and cost) were computed using generalized estimating equations (SAS 9.4). Results Admissions with NAFLD tripled from 2007-2014 at an average rate of 79/100,000 hospitalizations/year (P<0.0001), with a larger rate of increase among males vs. females (83/100,000 vs. 75/100,000), Hispanics vs. Whites vs. Blacks (107/100,000 vs. 80/100,000 vs. 48/100,000), and government-insured or uninsured patients vs. privately-insured (94/100,000 vs. 74/100,000). Males had higher mortality, LOS, and cost than females. Blacks had longer LOS and poorer discharge destination than Whites; while Hispanics and Asians incurred higher cost than Whites. Uninsured patients had higher mortality, longer LOS, and poorer discharge disposition than the privately-insured. Conclusions Hospitalizations with NAFLD are rapidly increasing in the US, with a disproportionately higher burden among certain demographic groups. Measures are required to arrest this ominous trend and to eliminate the disparities in outcome among patients hospitalized with NAFLD.
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Affiliation(s)
- Adeyinka Charles Adejumo
- Department of Medicine, North Shore Medical Center, Salem, MA (Adeyinka Charles Adejumo, Lydie Pani).,Department of Medicine, Tufts University Medical School, Boston, MA (Adeyinka Charles Adejumo, Lydie Pani).,Department of Medicine, University of Massachusetts Medical School, Worcester MA (Adeyinka Charles Adejumo, Ogooluwa Ojelabi).,Department of Public Health Program, University of Massachusetts Lowell, Lowell, MA (Adeyinka Charles Adejumo, Kelechi Lauretta Adejumo)
| | - Gbeminiyi Olanrewaju Samuel
- Department of Medicine, East Carolina University, Vidant Health Center, Greenville, NC (Gbeminiyi Olanrewaju Samuel)
| | - Oluwole Muyiwa Adegbala
- Department of Medicine, Englewood Hospital and Medical Center, Englewood, NJ (Oluwole Muyiwa Adegbala)
| | - Kelechi Lauretta Adejumo
- Department of Public Health Program, University of Massachusetts Lowell, Lowell, MA (Adeyinka Charles Adejumo, Kelechi Lauretta Adejumo)
| | - Ogooluwa Ojelabi
- Department of Medicine, University of Massachusetts Medical School, Worcester MA (Adeyinka Charles Adejumo, Ogooluwa Ojelabi)
| | - Olalekan Akanbi
- University of Kentucky College of Medicine, Division of Hospital Medicine, Lexington, KY (Olalekan Akanbi)
| | | | - Lydie Pani
- Department of Medicine, North Shore Medical Center, Salem, MA (Adeyinka Charles Adejumo, Lydie Pani).,Department of Medicine, Tufts University Medical School, Boston, MA (Adeyinka Charles Adejumo, Lydie Pani)
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13
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The association between patient education level and economic status on outcomes following surgical management of (fracture) non-union. Injury 2019; 50:344-350. [PMID: 30554898 DOI: 10.1016/j.injury.2018.12.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 10/01/2018] [Accepted: 12/04/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Socioeconomic disparities are an inherent and currently unavoidable aspect of medicine. Knowledge of these disparities is an essential component towards medical decision making, particularly among an increasingly diverse population. While healthcare disparities have been elucidated in a wide variety of orthopaedic conditions and management options, they have not been established among patients who present for treatment of an ununited fracture. The purpose of this study is to answer the following questions: 1) Following surgical management of (fracture) non-unions, are there differences in outcomes between differing ethnic groups? 2) Following surgical management of (fracture) non-unions, are there differences in outcomes between patients with differing education levels? 3) Following surgical management of (fracture) non-unions, are there differences in outcome between patients with differing incomes? METHODS Between September 2004 and December 2017, operatively treated patients who presented with a long bone fracture non-union were prospectively followed. These patients presented with a variety of fracture non-unions that underwent surgical intervention. Sociodemographic factors were recorded at presentation. Long-term outcomes were evaluated using the Short Musculoskeletal Function Assessment (SMFA), pain scores, post-operative complications and physical exam at latest follow up. The SMFA is a 46-item questionnaire, assessing patient functional and emotional response to musculoskeletal ailments. RESULTS Three-hundred-twenty-nine patients met inclusion criteria. Patients with a lower education had worse long-term functional outcomes (P < 0.001) and increased pain scores (P = 0.002) at latest follow-up. Patients who made less than $50,000 annually had worse long-term functional outcomes (P = 0.002) and reported higher pain scores (P = 0.003) following surgical management of (fracture) non-unions. Multiple linear regression demonstrated education level to be an independent predictor of long-term functional outcomes following surgical management of (fracture) non-unions (B= -0.154, 95% Confidence Interval [CI]=-10.96 to -1.26, P = 0.014). No differences existed in outcomes or pain scores between those of different ethnic groups. No differences existed regarding post-operative complications and time to union between patients of different ethnic groups, educational levels and income status. CONCLUSION Patients with lower education levels and individuals who make less than $50,000 annually have worse functional outcomes following surgical management of (fracture) non-unions. Orthopaedic trauma surgeons should therefore be aware of these disparities, and consider early interventions aimed at optimizing patient recovery in these subsets.
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L Snell D, Hipango J, Sinnott KA, Dunn JA, Rothwell A, Hsieh CJ, DeJong G, Hooper G. Rehabilitation after total joint replacement: a scoping study. Disabil Rehabil 2017; 40:1718-1731. [PMID: 28330380 DOI: 10.1080/09638288.2017.1300947] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The evidence supporting rehabilitation after joint replacement, while vast, is of variable quality making it difficult for clinicians to apply the best evidence to their practice. We aimed to map key issues for rehabilitation following joint replacement, highlighting potential avenues for new research. MATERIALS AND METHODS We conducted a scoping study including research published between January 2013 and December 2016, evaluating effectiveness of rehabilitation following hip and knee total joint replacement. We reviewed this work in the context of outcomes described from previously published research. RESULTS Thirty individual studies and seven systematic reviews were included, with most research examining the effectiveness of physiotherapy-based exercise rehabilitation after total knee replacement using randomized control trial methods. Rehabilitation after hip and knee replacement whether carried out at the clinic or monitored at home, appears beneficial but type, intensity and duration of interventions were not consistently associated with outcomes. The burden of comorbidities rather than specific rehabilitation approach may better predict rehabilitation outcome. Monitoring of recovery and therapeutic attention appear important but little is known about optimal levels and methods required to maximize outcomes. CONCLUSIONS More work exploring the role of comorbidities and key components of therapeutic attention and the therapy relationship, using a wider range of study methods may help to advance the field. Implications for Rehabilitation Physiotherapy-based exercise rehabilitation after total hip replacement and total knee replacement, whether carried out at the clinic or monitored at home, appears beneficial. Type, intensity, and duration of interventions do not appear consistently associated with outcomes. Monitoring a patient's recovery appears to be an important component. The available research provides limited guidance regarding optimal levels of monitoring needed to achieve gains following hip and knee replacement and more work is required to clarify these aspects. The burden of comorbidities appears to better predict outcomes regardless of rehabilitation approach.
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Affiliation(s)
- Deborah L Snell
- a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand.,b Burwood Academy of Independent Living (BAIL), Burwood Hospital , Christchurch , New Zealand
| | - Julia Hipango
- a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand
| | - K Anne Sinnott
- b Burwood Academy of Independent Living (BAIL), Burwood Hospital , Christchurch , New Zealand
| | - Jennifer A Dunn
- a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand
| | - Alastair Rothwell
- a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand
| | - C Jean Hsieh
- c MedStar Health Research Institute , Washington , DC , USA.,d MedStar National Rehabilitation Hospital , Washington , DC , USA
| | - Gerben DeJong
- d MedStar National Rehabilitation Hospital , Washington , DC , USA.,e Department of Rehabilitation Medicine , Georgetown University School of Medicine , Washington , DC , USA
| | - Gary Hooper
- a Department of Orthopaedic Surgery and Musculoskeletal Medicine , University of Otago Christchurch , Christchurch, New Zealand
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15
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Cherian JJ, Jinnah AH, Robinson K, O'Connor MI, Harwin SF, Mont MA. Prospective, Longitudinal Evaluation of Gender Differences After Total Hip Arthroplasty. Orthopedics 2016; 39:e391-6. [PMID: 26966941 DOI: 10.3928/01477447-20160307-06] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/10/2015] [Indexed: 02/03/2023]
Abstract
Temporal trends in survivorship, patient-reported outcomes, and activity levels following total hip arthroplasty were compared between 61 men and 127 women. Overall implant survivorship was excellent for both genders. Similar functional improvements were found between men and women out until 5 years. Some gender differences were observed: men had a faster time to functional recovery and higher preoperative Short-Form 12-item survey mental component scores, whereas women had a significant improvement in Short-Form 12-item survey mental component scores. Increased understanding of these differences by patients and surgeons, combined with gender-based interventions, may further advance outcomes for these patients.
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16
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Choi JY, Kuo YF, Goodwin JS, Lee J. Association of EMR Adoption with Minority Health Care Outcome Disparities in US Hospitals. Healthc Inform Res 2016; 22:101-9. [PMID: 27200220 PMCID: PMC4871840 DOI: 10.4258/hir.2016.22.2.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/29/2016] [Accepted: 04/26/2016] [Indexed: 01/23/2023] Open
Abstract
Objectives Disparities in healthcare among minority groups can result in disparate treatments for similar severities of symptoms, unequal access to medical care, and a wide deviation in health outcomes. Such racial disparities may be reduced via use of an Electronic Medical Record (EMR) system. However, there has been little research investigating the impact of EMR systems on the disparities in health outcomes among minority groups. Methods This study examined the impact of EMR systems on the following four outcomes of black patients: length of stay, inpatient mortality rate, 30-day mortality rate, and 30-day readmission rate, using patient and hospital data from the Medicare Provider Analysis and Review and the Healthcare Information and Management Systems Society between 2000 and 2007. The difference-in-difference research method was employed with a generalized linear model to examine the association of EMR adoption on health outcomes for minority patients while controlling for patient and hospital characteristics. Results We examined the association between EMR adoption and the outcomes of minority patients, specifically black patients. However, after controlling for patient and hospital characteristics we could not find any significant changes in the four health outcomes of minority patients before and after EMR implementation. Conclusions EMR systems have been reported to support better coordinated care, thus encouraging appropriate treatment for minority patients by removing potential sources of bias from providers. Also, EMR systems may improve the quality of care provided to patients via increased responsiveness to care processes that are required to be more time-sensitive and through improved communication. However, we did not find any significant benefit for minority groups after EMR adoption.
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Affiliation(s)
- Jae-Young Choi
- Program in Healthcare Management, College of Business, Hallym University, Chuncheon, Korea
| | - Yong-Fang Kuo
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - James S Goodwin
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Jinhyung Lee
- Department of Economics, Sungkyunkwan University, Seoul, Korea
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17
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Everink IHJ, van Haastregt JCM, van Hoof SJM, Schols JMGA, Kempen GIJM. Factors influencing home discharge after inpatient rehabilitation of older patients: a systematic review. BMC Geriatr 2016; 16:5. [PMID: 26755206 PMCID: PMC4709872 DOI: 10.1186/s12877-016-0187-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 01/03/2016] [Accepted: 01/05/2016] [Indexed: 12/24/2022] Open
Abstract
Background Although rehabilitation for older patients has the potential to improve function and prevent admission to nursing homes, returning home after discharge is not possible for all patients. Better understanding of patient factors related to discharge home may lead to more realistic rehabilitation goals, more targeted rehabilitation interventions and better preparation of both patient and informal caregiver for discharge. Various studies provided insight into factors related to home discharge after stroke rehabilitation, but we still lack insight into factors related to home discharge in non-stroke patients. Therefore, the aim of this review is to provide an overview of factors influencing home discharge in older non-stroke patients admitted to an inpatient rehabilitation unit. Methods A systematic literature search was executed in the databases PubMed, EMBASE, CINAHL and Web of Science to retrieve articles published between January 2000 and October 2015. The search focused on factors related to home discharge after rehabilitation for older patients. Studies were included if home discharge after rehabilitation was assessed as an outcome measure and if the non-stroke population was, on average, 65 years or older and admitted to an inpatient rehabilitation unit. Results Eighteen studies were included. The methodological quality was moderate to good in 15 studies. The factors significantly associated with home discharge are younger age, non-white ethnicity, being married, better functional and cognitive status, and the absence of depression. Conclusions Because various factors are significantly associated with home discharge of older non-stroke patients after rehabilitation, we recommend assessing these factors at admission to the rehabilitation unit. Further research into the factors that lack sufficient evidence concerning their association with home discharge is recommended. Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0187-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Irma H J Everink
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences and CAHPRI School for Public Health and Primary care, Maastricht University, Maastricht, The Netherlands.
| | - Jolanda C M van Haastregt
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences and CAHPRI School for Public Health and Primary care, Maastricht University, Maastricht, The Netherlands.
| | - Sofie J M van Hoof
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences and CAHPRI School for Public Health and Primary care, Maastricht University, Maastricht, The Netherlands.
| | - Jos M G A Schols
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences and CAHPRI School for Public Health and Primary care, Maastricht University, Maastricht, The Netherlands. .,Department of Family Medicine, Faculty of Health, Medicine and Life Sciences and CAHPRI School for Public Health and Primary care, Maastricht University, Maastricht, The Netherlands.
| | - Gertrudis I J M Kempen
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences and CAHPRI School for Public Health and Primary care, Maastricht University, Maastricht, The Netherlands.
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Jaffe KM, Jimenez N. Disparity in rehabilitation: another inconvenient truth. Arch Phys Med Rehabil 2015; 96:1371-4. [PMID: 25958194 PMCID: PMC4871110 DOI: 10.1016/j.apmr.2015.04.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 04/23/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Kenneth M Jaffe
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA; Department of Pediatrics, University of Washington, Seattle, WA; Department of Neurological Surgery, University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA
| | - Nathalia Jimenez
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
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McLawhorn AS, Bjerke-Kroll BT, Blevins JL, Sculco PK, Lee YY, Jerabek SA. Patient-Reported Allergies Are Associated With Poorer Patient Satisfaction and Outcomes After Lower Extremity Arthroplasty: A Retrospective Cohort Study. J Arthroplasty 2015; 30:1132-6. [PMID: 25702595 DOI: 10.1016/j.arth.2015.01.043] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 02/01/2023] Open
Abstract
Anecdotal evidence suggests that patient-reported allergies (PRAs) may exhibit prognostic value for patient-reported outcomes after lower extremity arthroplasty. This study's purpose was to investigate associations between PRAs, patient satisfaction and outcomes after total hip arthroplasty (THA) and total knee arthroplasty (TKA). PRAs in 274 patients undergoing primary THA and 257 patients receiving primary TKA were reviewed retrospectively. Satisfaction scores, baseline Western Ontario and McMaster Universities Arthritis Index (WOMAC), 2-year postoperative WOMAC and length-of-stay (LOS) were analyzed with PRAs. Increasing number of PRAs was significantly associated with worse satisfaction scores and worse WOMAC scores for TKA and THA, and it was significantly associated with increased LOS for TKA. These results may have implications for patient counseling and risk-adjusted outcome models.
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Affiliation(s)
| | | | - Jason L Blevins
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Peter K Sculco
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Yuo-yu Lee
- Department of Biostatistics, Hospital for Special Surgery, New York, New York
| | - Seth A Jerabek
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
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Lim JBT, Chou ACC, Yeo W, Lo NN, Chia SL, Chin PL, Tay DKJ, Yeo SJ. Comparison of patient quality of life scores and satisfaction after common orthopedic surgical interventions. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:1007-12. [DOI: 10.1007/s00590-015-1635-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/14/2015] [Indexed: 01/11/2023]
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Lee J. The impact of health information technology on disparity of process of care. Int J Equity Health 2015; 14:34. [PMID: 25889891 PMCID: PMC4392633 DOI: 10.1186/s12939-015-0161-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 03/17/2015] [Indexed: 11/10/2022] Open
Abstract
Introduction Disparities in the quality of health care and treatment among racial or ethnic groups can result from unequal access to medical care, disparate treatments for similar severities of symptoms, and wide divergence in general health status among individuals. Such disparities may be eliminated through better use of health information technology (IT). Investment in health IT could foster better coordinated care, improve guideline compliance, and reduce the likelihood of redundant testing, thereby encouraging more equitable treatment for underprivileged populations. However, there is little research exploring the impact of health IT investment on disparities of process of care. Methodology This study examines the impact of health IT investment on waiting times – from admission to the date of first principle procedure – among different racial and ethnic groups, using patient and hospital data for the state of California collected from 2001 to 2007. The final sample includes 14,056,930 patients admitted with medical diseases to 316 unique, acute-care hospitals over a seven-year period. The linear random intercept and slope model was employed to examine the impacts of health IT investment on waiting time, while controlling for patient, disease, and hospital characteristics. Results Greater health IT investment was associated with shorter waiting times, and the reduction in waiting times was greater for non-White than for White patients. This indicates that minority populations could benefit from health IT investment with regard to process of care. Conclusion Investments in health IT may reduce disparities in process of care. Electronic supplementary material The online version of this article (doi:10.1186/s12939-015-0161-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jinhyung Lee
- Department of Economics, Sungkyunkwan University, Seoul, Korea.
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22
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Singh JA, Lu X, Rosenthal GE, Ibrahim S, Cram P. Racial disparities in knee and hip total joint arthroplasty: an 18-year analysis of national Medicare data. Ann Rheum Dis 2014; 73:2107-15. [PMID: 24047869 PMCID: PMC4105323 DOI: 10.1136/annrheumdis-2013-203494] [Citation(s) in RCA: 274] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To examine whether racial disparities in usage and outcomes of total knee and total hip arthroplasty (TKA and THA) have declined over time. METHODS We used data from the US Medicare Program (MedPAR data) for years 1991-2008 to identify four separate cohorts of patients (primary TKA, revision TKA, primary THA, revision THA). For each cohort, we calculated standardised arthroplasty usage rates for Caucasian and African-American Medicare beneficiaries for each calendar year, and examined changes in disparities over time. We examined unadjusted and adjusted outcomes (30-day readmission rate, discharge disposition etc.) for Caucasians and African-Americans, and whether disparities decreased over time. RESULTS In 1991, the use of primary TKA was 36% lower for African-Americans compared with Caucasians (20.6 per 10,000 for African-Americans; 32.1 per 10,000 for Caucasians; p<0.0001); in 2008, usage of primary TKA was 40% lower for African-Americans (41.5 per 10,000 for African-Americans; 68.8 per 10,000 for Caucasians; p<0.0001) with similar findings for the other cohorts. Black-White disparities in 30-day hospital readmission increased significantly from 1991-2008 among three patient cohorts. For example in 1991 30-day readmission rates for African-Americans receiving primary TKA were 6% higher than for Caucasians; by 2008 readmission rates for African-Americans were 24% higher (p<0.05 for change in disparity). Similarly, black-white disparities in the proportion of patients discharged to home after surgery increased across the study period for all cohorts (p<0.05). CONCLUSIONS In an 18-year analysis of US Medicare data, we found little evidence of declines in racial disparities for joint arthroplasty usage or outcomes.
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MESH Headings
- Black or African American/statistics & numerical data
- Aged
- Aged, 80 and over
- Arthroplasty, Replacement, Hip/statistics & numerical data
- Arthroplasty, Replacement, Knee/statistics & numerical data
- Cohort Studies
- Female
- Healthcare Disparities/ethnology
- Humans
- Male
- Medicare
- Osteoarthritis, Hip/ethnology
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/ethnology
- Osteoarthritis, Knee/surgery
- Outcome Assessment, Health Care
- Patient Readmission/statistics & numerical data
- Reoperation/statistics & numerical data
- United States
- White People/statistics & numerical data
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Affiliation(s)
- Jasvinder A Singh
- Birmingham Veterans Affairs Medical Center, AL and the Departments of Medicine and Epidemiology, Medicine Service, University of Alabama at Birmingham, Birmingham, Alabama, USA Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Xin Lu
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA CADRE, Iowa City Veterans Administration Medical Center, Iowa City, Iowa, USA
| | - Gary E Rosenthal
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA CADRE, Iowa City Veterans Administration Medical Center, Iowa City, Iowa, USA
| | - Said Ibrahim
- Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, and the Perelman University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Peter Cram
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA CADRE, Iowa City Veterans Administration Medical Center, Iowa City, Iowa, USA
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Singh JA, Ramachandran R. Sex differences in characteristics, utilization, and outcomes of patient undergoing total elbow arthroplasty: a study of the US nationwide inpatient sample. Clin Rheumatol 2014; 35:723-31. [PMID: 25316506 DOI: 10.1007/s10067-014-2778-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 09/07/2014] [Indexed: 01/20/2023]
Abstract
The aim of this study was to compare patient characteristics, utilization rates, and outcomes after total elbow arthroplasty (TEA) by sex. We used the nationwide inpatient sample from 1998 to 2011 to study sex-related time trends in patient characteristics, comorbidity, and outcomes after TEA. We used chi-squared test, analysis of variance, and the Cochran-Armitage test to assess differences in utilization rates and characteristics over time by sex and logistic regression to compare mortality, discharge disposition, and the length of hospital stay by sex. Overall TEA utilization 0.45 in 1998 to 0.96 per 100,000 in 2011 (p < 0.0001). The utilization rates were significantly higher in females compared to males throughout the study period: 0.62 vs. 0.29 in 1998 (p < 0.0001) and 1.31 vs. 0.70 in 2011 (p < 0.0001). Compared to males, females undergoing TEA were more likely to be white (79.7 vs. 71.4 %; p < 0.0001), have rheumatoid arthritis (16.7 vs. 8.1 %; p < 0.0001), and have Deyo-Charlson index of 2 or more (11.3 vs. 5.9 %; p < 0.0001) and were older (63.5 vs. 51.4 years; p < 0.0001). Compared to males undergoing TEA, females had significantly lower mortality, 0.1 vs. 0.4 % (p = 0.03); lower proportion were discharged to home, 81.9 vs. 89.6 % (p < 0.0001), and fewer had has index hospital stay above the median, 30.0 vs. 33.0 % (p = 0.01); most differences were significant after multivariable adjustment. TEA utilization in the USA more than doubled in the last 14 years, with rates higher in females than males. Females had better outcomes after TEA than men. Preoperative risk communication should be sex-specific based on these data.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA.
- Department of Medicine at the School of Medicine, and Division of Epidemiology at the School of Public Health, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA.
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.
| | - Rekha Ramachandran
- Department of Medicine at the School of Medicine, and Division of Epidemiology at the School of Public Health, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA
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Bloo GJA, Hesselink GJ, Oron A, Emond EJJM, Damen J, Dekkers WJM, Westert G, Wolff AP, Calsbeek H, Wollersheim HC. Meta-analysis of operative mortality and complications in patients from minority ethnic groups. Br J Surg 2014; 101:1341-9. [PMID: 25093587 DOI: 10.1002/bjs.9609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 03/25/2014] [Accepted: 06/09/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Insight into the effects of ethnic disparities on patients' perioperative safety is necessary for the development of tailored improvement strategies. The aim of this study was to review the literature on safety differences between patients from minority ethnic groups and those from the ethnic majority undergoing surgery. METHODS PubMed, CINAHL, the Cochrane Library and Embase were searched using predefined inclusion criteria for available studies from January 1990 to January 2013. After quality assessment, the study data were organized on the basis of outcome, statistical significance and the direction of the observed effects. Relative risks for mortality were calculated. RESULTS After screening 3105 studies, 26 studies were identified. Nine of these 26 studies showed statistically significant higher mortality rates for patients from minority ethnic groups. Meta-analysis demonstrated a greater risk of mortality for these patients compared with patients from the Caucasian majority in studies performed both in North America (risk ratio 1·22, 95 per cent confidence interval 1·05 to 1·42) and outside (risk ratio 2·25, 1·40 to 3·62). For patients from minority groups, the length of hospital or intensive care unit stay was significantly longer in five studies, and complication rates were significantly higher in ten. Methods used to identify patient ethnicity were not described in 14 studies. CONCLUSION Patients from minority ethnic groups, in North America and elsewhere, have an increased risk of perioperative death and complications. More insight is needed into the causes of ethnic disparities to pursue safer perioperative care for patients of minority ethnicity.
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Affiliation(s)
- G J A Bloo
- Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands; Department of Anaesthesiology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Ellis HB, Howard KJ, Khaleel MA, Bucholz R. Effect of psychopathology on patient-perceived outcomes of total knee arthroplasty within an indigent population. J Bone Joint Surg Am 2012; 94:e84. [PMID: 22717836 DOI: 10.2106/jbjs.k.00888] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Factors other than surgical technique and implants impact patient outcomes following a total knee arthroplasty. The purpose of this study was to analyze the effects of psychopathology on the rate of improvement following total knee arthroplasty in an indigent population. METHODS One hundred and fifty-four consecutive indigent patients undergoing a primary total knee arthroplasty for arthritis were enrolled and available for follow-up. Patients were classified as having psychopathology on the basis of the presence of somatization, depression, and/or a panic or anxiety disorder as assessed with the Patient Health Questionnaire. Outcome measures were completed preoperatively and one year postoperatively. Univariate analyses, controlled for sex and age, were used to compare the rates of improvement in patients who exhibited psychopathology with the rates in those without psychopathology. RESULTS Fifty-four patients (35%) were diagnosed with at least one Axis-I psychological disorder. The psychopathology group showed significantly lower Short Form-36 mental component summary scores both at baseline and one year postoperatively (p < 0.001 for both). The psychopathology group also reported significantly higher levels of perceived disability at baseline on the Pain Disability Questionnaire (p < 0.001) and worse scores on the Western Ontario and McMaster Universities Osteoarthritis Index (p = 0.004); however, the improvement on both of these scales did not differ significantly between the two groups (p > 0.05). The Knee Society Score differed significantly between the two groups at both baseline and the one-year follow-up evaluation (p = 0.003 and p = 0.001, respectively), but there was no significant difference in the total rate of improvement between the two comparison groups (p > 0.05). CONCLUSIONS Not only is there a high prevalence of psychopathology in the indigent population, but psychopathology may result in lower patient-perceived outcome scores at one year after a total knee arthroplasty. Even though outcome scores may be worse for patients with psychopathology, our study showed that these patients still benefit, with the same degree of improvement in function.
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Affiliation(s)
- Henry B Ellis
- Children's Medical Center Sports Medicine, Children's Medical Center Legacy, 7609 Preston Road P3.07, Plano, TX 75024, USA.
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The effect of geriatric rehabilitation on physical performance and pain in men and women. Arch Gerontol Geriatr 2011; 52:e129-33. [DOI: 10.1016/j.archger.2010.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Revised: 09/05/2010] [Accepted: 09/07/2010] [Indexed: 11/21/2022]
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Quality of Life of Men and Women with Osteoarthritis of the Hip and Arthroplasty. Am J Phys Med Rehabil 2009; 88:328-35. [DOI: 10.1097/phm.0b013e318194fa24] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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