Nationwide study shows disparities in outpatient care for common orthopaedic problems

March 09, 2020

March 9, 2020 - Racial/ethnic minorities, people with lower incomes, and other groups are less likely to receive office-based care for common musculoskeletal conditions, reports a nationwide study in Clinical Orthopaedics and Related Research®(CORR®), a publication of The Association of Bone and Joint Surgeons®. The journal is published in the Lippincott portfolio by Wolters Kluwer.

Some of the same characteristics are linked to higher use of more-expensive emergency department (ED) care for orthopaedic conditions, according to the new research by Nicholas M. Rabah and colleagues of Case Western Reserve University School of Medicine, Cleveland. "It is imperative for orthopaedic surgeons to continue to collaborate with policy makers to create targeted interventions that improve access to and use of outpatient orthopaedic care to reduce healthcare expenditures," the researchers write.

Patient Factors Linked to Lower Use of Outpatient Orthopaedic Care, Higher Use of ED Care

The study included data on more than 63,500 patients receiving office-based or ED care for common orthopaedic conditions between 2007 and 2015, drawn from the nationally representative Medical Expenditure Panel Survey. The study focused on eight categories of non-emergent musculoskeletal conditions--for example, osteoarthritis, fractures, and strains and sprains. (The study did not include spinal disorders, which can be treated by either neurosurgeons or orthopaedic surgeons.)

Several sociodemographic factors were linked to lower use of office-based care for musculoskeletal conditions. After adjustment for other characteristics, black and Hispanic patients were about 20 percent less likely to receive outpatient care, compared to white patients.

Use of outpatient orthopaedic care was also lower for Americans with household incomes below the federal poverty line, without at least a high school education, and without private insurance (either on public insurance or uninsured).

In contrast, patients with lower income, lower education, and public insurance status were more likely to receive ED care for these nonemergent musculoskeletal conditions. Hispanic patients also were more likely to receive ED care, although black patients were not. For most of the eight conditions studied, expenditures were significantly higher for ED care than for office-based care.

There are well-documented disparities in healthcare use in the United States. Musculoskeletal disorders are a major health burden, affecting more Americans than either cardiovascular or respiratory disease and accounting for more than $162 billion in healthcare spending per year (based on 2012-14 data).

Office-based care is thought to be the most appropriate site of care for common musculoskeletal conditions. The new study is one of the first to link specific sociodemographic factors to disparities in the use outpatient orthopaedic care.

Multiple factors may contribute to the observed disparities, including differences in health literacy, beliefs about health and disease, and lack of social support and resources to recognize diseases and make informed decisions. Mr. Rabah and coauthors conclude: "[O]rthopaedic surgeons should focus on improving communication with patients of all backgrounds to help them identify musculoskeletal symptoms that warrant office-based orthopaedic care versus ED care."
-end-
Click here to read "Are There Nationwide Socioeconomic and Demographic Disparities in the Use of Outpatient Orthopaedic Services?" DOI: 10.1097/CORR.0000000000001168

About CORR®

Devoted to disseminating new and important orthopaedic knowledge, Clinical Orthopaedics and Related Research® is a leading peer-reviewed orthopaedic journal and a publication of The Association of Bone and Joint Surgeons®. CORR® brings readers the latest clinical and basic research and informed opinions that shape today's orthopaedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system.

About the Association of Bone & Joint Surgeons®

The mission of The Association of Bone and Joint Surgeons® is to advance the science and practice of orthopaedic surgery by creating, evaluating, and disseminating new knowledge and by facilitating interaction among all orthopedic specialties. Founded in 1947 as the "American Bone and Joint Association," ABJS membership is offered by invitation only to orthopaedic surgeons who have been certified by the American Board of Orthopaedic Surgery.

About Wolters Kluwer

Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the clinicians, nurses, accountants, lawyers, and tax, finance, audit, risk, compliance, and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with advanced technology and services.

Wolters Kluwer reported 2018 annual revenues of €4.3 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 18,600 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students with advanced clinical decision support, learning and research and clinical intelligence. For more information about our solutions, visit http://healthclarity.wolterskluwer.com and follow us on LinkedIn and Twitter @WKHealth.

For more information, visit http://www.wolterskluwer.com, follow us on Twitter, Facebook, LinkedIn, and YouTube.

Wolters Kluwer Health

Related Healthcare Articles from Brightsurf:

How to protect healthcare workers from COVID-19
Researchers are developing simple and inexpensive tools--like a DIY ventilator--to treat patients more effectively and prevent disease transmission in hospitals.

Healthcare as a climate solution
Although the link may not be obvious, healthcare and climate change -- two issues that pose major challenges around the world -- are in fact more connected than society may realize.

Healthcare's earthquake: Lessons from COVID-19
Leaders and clinician researchers from Beth Israel Lahey Health propose using complexity science to identify strategies that healthcare organizations can use to respond better to the ongoing pandemic and to anticipate future challenges to healthcare delivery.

Poor women in Bangladesh reluctant to use healthcare
A study, published in PLOS ONE, found that the women living in Dhaka slums were reluctant to use institutionalised maternal health care for fear of having to make undocumented payments, unfamiliar institutional processes, lack of social and family support, matters of honour and shame, a culture of silence and inadequate spousal communication on health issues.

Women and men executives have differing perceptions of healthcare workplaces according to a survey report in the Journal of Healthcare Management
Healthcare organizations that can attract and retain talented women executives have the advantage over their peers, finds a special report in the September/October issue of the Journal of Healthcare Management, an official publication of the American College of Healthcare Executives (ACHE).

Greater financial integration generally not associated with better healthcare quality
New findings from a Dartmouth-led study, published in the August issue of Health Affairs, show that larger, more integrated healthcare systems do not generally deliver better quality care, and that there is significant variation in quality scores across hospitals and physician practices, regardless of whether they are independent or owned by larger systems.

Wearable sensor may help to assess stress in healthcare workers
A wearable biosensor may help monitor stress experienced by healthcare professionals, according to a study published in Physiological Reports.

Healthcare innovators focus on 'quality as a business strategy' -- update from Journal of Healthcare Quality
Despite two decades of effort -- targeting care processes, outcomes, and most recently the value of care - progress has been slow in closing the gap between quality and cost in the US healthcare system.

How runaway healthcare costs are a threat to older adults and what to do about it
Empowering Medicare to directly negotiate drug prices, accelerating the adoption of value-based care, using philanthropy as a catalyst for reform and expanding senior-specific models of care are among recommendations for reducing healthcare costs published in a new special report and supplement to the Winter 2019-20 edition of Generations, the journal of the American Society of Aging (ASA).

How can healthcare achieve real technology driven transformation?
Real transformation in healthcare through the adoption of artificial intelligence (AI), robotics, telecommunications, and other advanced technologies could provide significant improvements in healthcare quality, productivity, and access.

Read More: Healthcare News and Healthcare Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.