» Back to list of all Management eBriefs
|Issue 42||October 2011|
A Review of the Literature: Comparison of Joint Replacement Disparities in VA and Non-VA Settings
The leading cause of disability in the U.S. is osteoarthritis, and there is no known cure. Consequently, osteoarthritis is managed with a variety of treatments to reduce disability, improve function, and alleviate symptoms. The most effective surgical option for moderate to severe osteoarthritis in the knee or hip is total joint replacement (TJR), which is often considered appropriate in cases where non-surgical treatments have not brought adequate relief. TJR is considered the fastest-growing elective surgery in the nation, if not the world.
Although TJR is highly successful at treating advanced hip or knee osteoarthritis, there is a large body of evidence that disparities exist in the use of TJR in non-VA settings. Investigators at the VA Evidence-based Synthesis Program at the West Los Angeles VAMC conducted a review of the literature from 1966 through 2011 to compare what is known about disparities in TJR in VA healthcare settings to disparities outside the VA.
After screening more than 285 articles, 69 articles were chosen in order to answer these three key questions:
Suggestions for Future Research
Future studies could assess the current utilization of TJR in a national or representative sample of Veterans and VISNs to establish the magnitude of any differences in utilization in TJR between male and female Veterans and those of different races. If current data confirm different utilization rates, an in-depth examination should examine the extent to which differences reflect different need for surgery based on severity of symptoms and other clinical factors. Third, if disparities appear to exist even after controlling for appropriate need for surgery, mixed-method types of research will be necessary to help establish the causes and barriers that are contributing to these disparities. This research should examine patient- and provider-level factors and also system-level factors, which may be particularly amenable to the types of quality improvement initiatives that an integrated healthcare system, such as the VA, can implement well. Lastly, based on the results of all the above, VA should test interventions to diminish disparities.
This report is a product of the HSR&D Evidence-based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers -- and to disseminate these reports throughout VA.
Please feel free to forward this information to others!
This Management eBrief is a product of the HSR&D Evidence Synthesis Program (ESP). ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.
This report is a product of the HSR&D Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers - and to disseminate these reports throughout VA.
See the full reports online.