Race and Preference for Knee Replacement


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Race and Preference for Knee Replacement

  1. 1. REPAIR and ACTION Studieswith Said Ibrahim, MD, MPH Jessica Clymer SUMR 2011 Scholar
  2. 2.  Background information Project overview Methods Significance/Aims My role What I learned Thank yous!
  3. 3.  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
  4. 4.  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
  5. 5.  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.
  6. 6.  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.
  7. 7.  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.
  8. 8.  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.
  9. 9.  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
  10. 10.  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)
  11. 11.  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
  12. 12.  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