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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1006 — A Randomized, Controlled Educational Intervention to Reduce Racial Variation in Elective Knee Replacement

Ibrahim SAHanusa B, and Hannon M, CHERP, PVAHCS; Kresevic D, Cleveland VAMC; Long J, and Kwoh CK, CHERP, PVAHCS;

Objectives:
African American (AA) patients are significantly less likely to undergo knee replacement (TKR) for the management of knee osteoarthritis (OA). We examined the effectiveness of a patient-centered educational intervention on patient preference, expectations, and likelihood of referral to orthopedics.

Methods:
In a 2x2 factorial design, we randomized 663 VA primary care patients with knee OA into one of 4 study arms: 1) attention control (AC); 2) Knee OA Decision Aid (DA); 3) Motivational Interviewing (MI); or 4) both DA and MI. To be eligible, patients had to have moderate to severe knee OA (i.e., WOMAC score = 39) and radiologic evidence of knee OA. Key study outcomes were 1) willingness to have a TKR at 1, 3, and 12 months post intervention; and 2) receipt of a referral to orthopedics within 12 months. Comparisons among the groups on the primary and secondary outcomes were completed with mixed effect regressions for the willingness and knee expectation measures and logistic regressions for discussions with PCPs, receipt of a referral to orthopedics, and TKR within 12 months.

Results:
The study analyzed for outcomes 161 (AC), 162 (DA), 158 (MI) and 158 (DA/MI), respectively. There were no statistically significant differences between the study arms in any of the baseline demographic and clinical characteristics. Baseline preference was 64% with no difference among the groups. At one month there was a statistically significant, but short-term increase in willingness for all groups (74%) with all groups returning to baseline levels of willingness at 3 and 12 months post-intervention. The mean expectation score at baseline was 2.24 (SD of 0.75) with no significant changes over time and no differences among the groups at any assessment. Comparisons among the groups on the PCP discussion, referral to orthopedics, and attending an appointment with an orthopedic surgeon also did not significantly differ among the groups.

Implications:
In this sample of AA patients with knee OA, a patient-centered educational intervention consisting of either a Decision-Aid, MI, or a combination of both did not significantly impact patient preference for TKR, expectations of TKR, or referral to an orthopedic surgeon.

Impacts:
Patient-centered educational intervention may not reduce TKR disparities.


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