REPAIR and ACTION Studieswith Said Ibrahim, MD, MPH Jessica Clymer SUMR 2011 Scholar
Background information Project overview Methods Significance/Aims My role What I learned Thank yous!
The clinical issue Arthritis or rheumatism is the most common cause of disability among US adults (17.5% of all disability) Key findings from previous studies Attitudes toward treatment options for osteoarthritis vary by race Patient preference varies by race and is a function of surgical outcome expectations Patient race is not a significant predictor of surgical recommendation at the orthopedic level
Joint Replacement surgery is an effective treatment option for osteoarthritis More than 90% report improvement in pain/function Less than 1% mortality rate Joint prosthesis lasts up to 20 years .5 million joint replacement surgeries are done annually State knee replacement rate is up 45% between 2000- 2004 Marked variation in the utilization of knee/hip joint replacement in the African American community Patient factors are considered to be the cause in variation of treatments
Consider patient factors: Attitudes toward joint replacement Knowledge about the treatment Patient preferences Surgical outcome expectancy Lookingto see how an educational intervention affects patients’ decisions about their knee pain.
Recruiting African American patients over the age of 50 with a history of osteoarthritis. Screened for exclusion factors and used the WOMAC scale to ensure severe knee pain assesses the pain, joint stiffness, physical, social & emotional function of a person with osteoarthritis in determining the overall level of disability. Patients undergo a baseline phone interview. For the REPAIR study, they are met at their primary care appointment for an educational intervention. For the ACTION study, they are met at their orthopedic specialist appointment for an educational intervention.
Educationalintervention is done when a staff member meets the patient before his/her appointment, and it consists of a DVD explaining knee replacement surgery. For REPAIR patients, they also have a discussion after the video to answer questions. Patients in the control group receive a pamphlet prior to their appointments that discusses different treatment options for knee osteoarthritis other than knee replacement surgery.
Forthe REPAIR study, patients complete a 2- week, 3-month and 1-year follow up phone interview about their views on their knee pain and knee replacement surgery. 1 year after their educational intervention, we will look into their medical records. ForACTION study, we look into their records after six months, and do a 1-year follow up phone interview.
More utilization of an effective treatment Potential opportunity to improve the quality of life for minority patients with osteoarthritis Potential opportunity to improve management of other deadly co morbidities Model for understanding how education shapes elective treatment decisions
Began the summer doing quality assurance Learned how to do follow-up interviews Eventually learned baseline and screening interviews Helped with recruitment: mailing and screening patients from the list of potential participants from UPHS (Penn Care, Presbyterian, Ralston, Penn Family Care)
Trackingand entering data Phone surveys Recruitment strategies: working within UPHS to find patients, sending letters and following up with phone calls, advertising with Metro and SEPTA, expanding to the VA and possibly other outside providers IRB Effectivetime management! Job application process
Principal investigator and my mentor for the SUMR program, Dr. Said Ibrahim My wonderful TEAM of mentors: Heather, Brandon, Ro, Becky, Erik, Emma, Craig Joanne Levy, Lissy Madden and LDI Staff Fellow scholars