Study Shows VA Patient-Provider Communication Does Not Contribute to Racial Disparities in Use of Total Joint Replacement

BACKGROUND:
There are well-documented, nation-wide racial disparities in the use of total joint replacement (TJR) as a treatment for advanced knee and hip osteoarthritis. In particular, African American patients are significantly less likely than white patients to undergo knee or hip TJR. Reasons for these disparities remain unclear, although research suggests they are not explained by differences in healthcare access or clinical need. What has not been well-studied as a contributing factor to racial disparities in TJR is the role of patient-provider communication regarding the management of knee/hip osteoarthritis in the orthopedic setting. This study examined whether there were racial differences in patient-provider communication about treatment of chronic knee/hip osteoarthritis in African American (n=106) and white Veterans (n=296) referred to two VA orthopedic clinics from 12/05 through 7/08. Investigators analyzed audio recordings of patient-provider interactions to assess: the types of statements made by providers and Veterans, the provider-to-patient ratio of communication, and the display of positive affect by Veterans and providers. Investigators also evaluated Veteran surveys about their visits, as well as medical records to determine whether or not TJR had been recommended based on the visit.

FINDINGS:

• Communication between VA orthopedic surgeons and patients regarding the management of chronic knee/hip osteoarthritis did not, for the most part, vary by patient race.
• No racial differences were observed with regard to length of visit, overall amount of dialogue, discussion of psychosocial issues, Veteran activation/engagement statements, physician verbal dominance, display of positive affect by Veterans or providers, or discussion related to informed decision-making. However, visits with African American Veterans contained less discussion of biomedical topics and more rapport-building statements than visits with white Veterans.
• These findings diminish the potential role of communication in VA orthopedic settings as an explanation for racial disparities in the use of total joint replacement.

LIMITATIONS:

• This study was conducted in only two VA facilities.
• Investigators had no information on characteristics of the participating surgeons, so could not adjust for specific provider characteristics in the analyses.
• Participating surgeons were aware that the study was being conducted by researchers who study racial disparities in healthcare, which could have affected surgeons’ communicative behavior.

AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 04-137). Drs. Hausmann, Hanusa, and Ibrahim are part of HSR&D’s Center for Health Equity Research and Promotion, Pittsburgh/Philadelphia, PA.

Hausmann L, Hanusa B, Kresevic D,…Ibrahim S. Orthopedic Communication about Osteoarthritis Treatment: Does Patient Race Matter? Arthritis Care & Research January 10, 2011;e-pub ahead of print.