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Wednesday, October 24, 2007 - 11:45 AM
J-6

RACE AND PATIENT-PROVIDER CONCORDANCE ON TREATMENT RECOMMENDATION FOR JOINT REPLACEMENT

Leslie R.M. Hausmann, PhD1, Maria Mor, PhD2, Ming Geng, MS2, Susan L. Zickmund, PhD2, Bruce S. Ling, MD, MPH2, Denise Kresevic, RN, PhD3, Howard S. Gordon, MD4, Peter Z. Cohen, MD2, Richard Grant, MD3, and Said A. Ibrahim, MD, MPH2. (1) VA Pittsburgh Healthcare System Center for Health Equity Research and Promotion, Pittsburgh, PA, (2) VA Pittsburgh Healthcare System Center for Health Equity Research and Promotion, University of Pittsburgh, Pittsburgh, PA, (3) Louis Stokes DVA Medical Center, University Hospitals Case Medical Center, Cleveland, OH, (4) Jesse Brown VAMC, VA HSR&D Center for Management of Complex Chronic Care, and University of Illinois at Chicago, Chicago, IL

Purpose: African Americans choose joint replacement as a treatment for advanced knee/hip osteoarthritis less often than Whites, but reasons for this disparity remain unknown. The decision to undergo this elective surgery may be complicated by miscommunication between patients and orthopedic surgeons about whether joint replacement is recommended. In this study, patients with knee/hip osteoarthritis discussed treatment options with orthopedic surgeons. We examined concordance between patients' understanding of whether joint replacement was recommended and the recommendations documented by surgeons in patients' medical records.

Methods: The sample included patients from the Pittsburgh and Cleveland VA medical centers with chronic knee/hip pain who consulted with an orthopedic surgeon. After the consultation, patients were surveyed regarding whether the surgeon recommended joint replacement. Patients' race, age, income, and education were also recorded. Trained research staff abstracted from electronic medical records whether the surgeon recommended joint replacement. Concordance between patient-reported and surgeon-recorded recommendations for joint replacement was assessed using a kappa statistic to account for agreement by chance alone. Whether concordance varied by race of patient was examined using a Fisher's exact test and a multiple logistic regression analysis that adjusted for potential confounders.

Results: The sample (N = 292) was 82% White, 18% African American, mostly male (95%), and had a mean age of 62 (SD = 8.91). Overall, 33% of patient self-reports and 14% of surgeon reports indicated that joint replacement had been recommended. Although 79% of patients' self-reports were concordant with surgeons' documented recommendations, the kappa statistic indicated only moderate agreement (Kappa = .46). Concordance tended to be less frequent for African American patients compared to White patients (69% vs. 82%; p = .06). After adjusting for patient age, income, education, site of care, and clustering by provider, the odds of concordance for African American patients was half that of White patients (OR = .50, 95% CI = .28 – .87).

Conclusions: Concordance between patient-reported and surgeon-documented recommendations for joint replacement was only moderate, with African American patients showing less concordance than White patients. This suggests that some patients, especially African Americans, leave orthopedic consultations without a clear understanding of the recommended treatment plan. Improving patient-surgeon communication may aid in the decision-making process for patients considering joint replacement and may help reduce racial disparities in joint replacement utilization.


See more of Concurrent Abstracts J: Risk, Utility, and Health Services
See more of The 29th Annual Meeting of the Society for Medical Decision Making (October 20-24, 2007)