Addressing racial disparities in orthopedic care

Recent data published by Baylor College of Medicine show that despite improvements in surgical pathways and overall health profiles among patients undergoing joint replacement surgery, lower outcomes continue to occur among minorities, particularly Black and Hispanic individuals. So why do such health disparities exist?

Experts at Baylor’s Joseph Barnhart Department of Orthopedic Surgery are calling for expansion of national databases to include more granular information to answer this question. Based on a number of studies led by Dr. Mohamad Halawi, associate professor of orthopedic surgery, current surgical databases lack information on factors such as social determinants of health, patient reported outcome measures, and point-of-care quality metrics that collectively prevent an impactful root cause analysis.

In a series of six studies that utilized a large national database, Halawi and colleagues presented the most comprehensive and up-to-date overview of the state of racial and ethnic health disparities pertaining to joint replacement, the most commonly performed orthopedic procedure. All major racial and ethnic groups defined by the National Institutes of Health were analyzed.

“Even after controlling for differences in demographic, comorbidity and perioperative factors, health disparities persisted, a finding that confirms one’s race and ethnicity have broader associations that are not captured by traditional disease-focused approach,” said Halawi, who serves as the chief quality officer for musculoskeletal services at Baylor St. Luke’s Medical Center.

Halawi emphasizes the importance of understanding social factors that may impact patient outcomes, including language, education level, income, living environment and caregiver support. Additionally, Halawi emphasizes the importance of assessing the outcomes of surgery from the patient’s perspective and increasing transparency regarding surgeon and hospital quality performance metrics.

Despite the persistence of health disparities, some findings are promising. When the two minority groups experiencing the most disparities, Blacks and Hispanics, were analyzed over time, positive trends in terms of procedure utilization, health profiles and outcomes were observed. These findings provide hope that efforts to tackle health disparities are making a difference, but more work remains to be done.

In another related study, Halawi and colleagues looked at the clinical practice guidelines for osteoarthritis, a disease that impacts millions of people across the country. They found that outside of orthopedics and rheumatology specialties, most other clinical specialties do not have universal clinical practice guidelines that they follow in treating patients with osteoarthritis. Because of historic disparities in access to specialized care among Black and Hispanic patients, absence of universal clinical practice guidelines may further propagate health disparities due to wide variations in treatment recommendations, referral patterns and timing of surgery.

As a result of this finding, Halawi and colleagues also are calling for action on a national level for a multidisciplinary approach to identify standardized recommendations for osteoarthritis. This would give guidance to physicians and would ensure that only evidence-based care is provided to all patients across the board.

Halawi and colleagues hope to make Baylor College of Medicine a premier institution in tackling this public health priority through more patient-centered electronic platforms that not only actively engage patients but also track their outcomes in real time.