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Larrieux S1
1Northeastern University, Physical Therapy, Movement and Rehabilitation Sciences, Boston, MA, United States
Background: Racial/ethnic disparities have been a long-standing problem associated with minority healthcare and health status. The ramification of persistent disparate healthcare is the overall poorer health status of minority groups in comparison to non-minority groups. The source of poor minority health status has been attributed to various social, economic & individual causes.
Medicare is the national health insurance program for United States senior citizens. Many of these seniors experience the symptoms associated with osteoarthritis. More than 60% of all total hip replacement (THR) procedures are performed on Medicare enrollees in surgical attempts to alleviate these symptoms.
Purpose: This study aimed to address the paucity of empirical studies examining the relationship between race/ethnicity and the post-surgical functional outcomes of individuals who had a THR. Specifically, this research was conducted to examine the functional outcomes across racial/ethnic Medicare beneficiary groups who underwent a common elective surgical orthopedic procedure (THR) and received post-acute care physical rehabilitation at home.
Methods: This was a retrospective cohort research design study based on secondary analysis of Centers for Medicare and Medicaid Services (CMS) administrative claims and assessment data. We reviewed the files of 21, 448 beneficiaries who had a primary THR [ICD - 9 code 81.51] in 2012 and were discharged from the acute care hospital with post-acute physical rehabilitation through a CMS certified home health care agency. Analysis of functional outcomes was conducted based upon the beneficiaries transfer and ambulatory status assessed within one episode of home health care services (60 days) using the Outcome and Assessment Information Set (OASIS),
The Statistical Analysis System (SAS) Version 9.3 (SAS Institute, Cary NC) was used for all data analyses. Bivariate, multivariate logistic and multinomial regression analyses were performed to examine the effect of each individual variable on the outcomes of interest (transfer and ambulation ability).
Results: The study sample was predominantly non-Hispanic white (93.27%); female (56.20%); between 65 - 74 years old (55%) with 1-7 co-morbidities urban residents (83.49%). Race and ethnicity were the factors consistently found to have a statistically significant impact on transfer and ambulation outcomes. Compared to the white reference group, the Hispanic and Black cohorts demonstrated significant difference of dependency with transfer ability; OR: 5.201 (1.424, 18.989), OR: 1.386 (1.211, 1.585) respectively. When all variables were considered in the multivariate analyses for ambulation, minority groups were 1.3 (1.152, 1.544) to 2.6 (1.668, 3.975) times more likely to be moderately to totally dependent in their ambulation/locomotion abilities.
Conclusion(s): Disparities in the functional outcomes examined in this study sample persist across racial/ethnic cohorts after controlling for potentially confounding factors such as, age, gender and the number comorbidities.
Implications: Persistent disparity in health care outcomes and its root causes are likely to result in increased economic burden to society as well as unnecessary pain and suffering for the individual patient. It is important to implement professional educational programs designed to address the root causes of health care disparities, engage health care professionals, public health experts, the legislature and raise their awareness of this important public health issue.
Keywords: Functional Outcomes, Racial/ethnic disparities, Total hip replacement
Funding acknowledgements: Purchase of the CMS data was supported in part by APTA 2011 Minority Faculty Development Scholarship Award
Medicare is the national health insurance program for United States senior citizens. Many of these seniors experience the symptoms associated with osteoarthritis. More than 60% of all total hip replacement (THR) procedures are performed on Medicare enrollees in surgical attempts to alleviate these symptoms.
Purpose: This study aimed to address the paucity of empirical studies examining the relationship between race/ethnicity and the post-surgical functional outcomes of individuals who had a THR. Specifically, this research was conducted to examine the functional outcomes across racial/ethnic Medicare beneficiary groups who underwent a common elective surgical orthopedic procedure (THR) and received post-acute care physical rehabilitation at home.
Methods: This was a retrospective cohort research design study based on secondary analysis of Centers for Medicare and Medicaid Services (CMS) administrative claims and assessment data. We reviewed the files of 21, 448 beneficiaries who had a primary THR [ICD - 9 code 81.51] in 2012 and were discharged from the acute care hospital with post-acute physical rehabilitation through a CMS certified home health care agency. Analysis of functional outcomes was conducted based upon the beneficiaries transfer and ambulatory status assessed within one episode of home health care services (60 days) using the Outcome and Assessment Information Set (OASIS),
The Statistical Analysis System (SAS) Version 9.3 (SAS Institute, Cary NC) was used for all data analyses. Bivariate, multivariate logistic and multinomial regression analyses were performed to examine the effect of each individual variable on the outcomes of interest (transfer and ambulation ability).
Results: The study sample was predominantly non-Hispanic white (93.27%); female (56.20%); between 65 - 74 years old (55%) with 1-7 co-morbidities urban residents (83.49%). Race and ethnicity were the factors consistently found to have a statistically significant impact on transfer and ambulation outcomes. Compared to the white reference group, the Hispanic and Black cohorts demonstrated significant difference of dependency with transfer ability; OR: 5.201 (1.424, 18.989), OR: 1.386 (1.211, 1.585) respectively. When all variables were considered in the multivariate analyses for ambulation, minority groups were 1.3 (1.152, 1.544) to 2.6 (1.668, 3.975) times more likely to be moderately to totally dependent in their ambulation/locomotion abilities.
Conclusion(s): Disparities in the functional outcomes examined in this study sample persist across racial/ethnic cohorts after controlling for potentially confounding factors such as, age, gender and the number comorbidities.
Implications: Persistent disparity in health care outcomes and its root causes are likely to result in increased economic burden to society as well as unnecessary pain and suffering for the individual patient. It is important to implement professional educational programs designed to address the root causes of health care disparities, engage health care professionals, public health experts, the legislature and raise their awareness of this important public health issue.
Keywords: Functional Outcomes, Racial/ethnic disparities, Total hip replacement
Funding acknowledgements: Purchase of the CMS data was supported in part by APTA 2011 Minority Faculty Development Scholarship Award
Topic: Outcome measurement; Older people
Ethics approval required: Yes
Institution: Northeastern University
Ethics committee: Institutional Review Board
Ethics number: 41073
All authors, affiliations and abstracts have been published as submitted.
