HealthMarch 09, 2020

Nationwide study shows disparities in outpatient care for common orthopaedic problems

Racial/ethnic minorities, people with lower incomes, and other groups are less likely to receive office-based care for common musculoskeletal conditions, reports a nationwide study in Clinical Orthopaedics and Related Research® (CORR®), a publication of The Association of Bone and Joint Surgeons®. The journal is published in the Lippincott portfolio by Wolters Kluwer.

Some of the same characteristics are linked to higher use of more-expensive emergency department (ED) care for orthopaedic conditions, according to the new research by Nicholas M. Rabah and colleagues of Case Western Reserve University School of Medicine, Cleveland. “It is imperative for orthopaedic surgeons to continue to collaborate with policy makers to create targeted interventions that improve access to and use of outpatient orthopaedic care to reduce healthcare expenditures,” the researchers write.

Patient factors linked to lower use of outpatient orthopaedic care, higher use of ED care

The study included data on more than 63,500 patients receiving office-based or ED care for common orthopaedic conditions between 2007 and 2015, drawn from the nationally representative Medical Expenditure Panel Survey. The study focused on eight categories of non-emergent musculoskeletal conditions—for example, osteoarthritis, fractures, and strains and sprains. (The study did not include spinal disorders, which can be treated by either neurosurgeons or orthopaedic surgeons.)

Several sociodemographic factors were linked to lower use of office-based care for musculoskeletal conditions. After adjustment for other characteristics, black and Hispanic patients were about 20 percent less likely to receive outpatient care, compared to white patients.

Use of outpatient orthopaedic care was also lower for Americans with household incomes below the federal poverty line, without at least a high school education, and without private insurance (either on public insurance or uninsured).

In contrast, patients with lower income, lower education, and public insurance status were more likely to receive ED care for these nonemergent musculoskeletal conditions. Hispanic patients also were more likely to receive ED care, although black patients were not. For most of the eight conditions studied, expenditures were significantly higher for ED care than for office-based care.

There are well-documented disparities in healthcare use in the United States. Musculoskeletal disorders are a major health burden, affecting more Americans than either cardiovascular or respiratory disease and accounting for more than $162 billion in healthcare spending per year (based on 2012-14 data).

Office-based care is thought to be the most appropriate site of care for common musculoskeletal conditions. The new study is one of the first to link specific sociodemographic factors to disparities in the use outpatient orthopaedic care.

Multiple factors may contribute to the observed disparities, including differences in health literacy, beliefs about health and disease, and lack of social support and resources to recognize diseases and make informed decisions. Mr. Rabah and coauthors conclude: “[O]rthopaedic surgeons should focus on improving communication with patients of all backgrounds to help them identify musculoskeletal symptoms that warrant office-based orthopaedic care versus ED care.”

Click here to read “Are There Nationwide Socioeconomic and Demographic Disparities in the Use of Outpatient Orthopaedic Services?”

DOI: 10.1097/CORR.0000000000001168

About CORR®

Devoted to disseminating new and important orthopaedic knowledge, Clinical Orthopaedics and Related Research® is a leading peer-reviewed orthopaedic journal and a publication of The Association of Bone and Joint Surgeons®. CORR® brings readers the latest clinical and basic research and informed opinions that shape today's orthopaedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system.

About the Association of Bone & Joint Surgeons®

The mission of The Association of Bone and Joint Surgeons® is to advance the science and practice of orthopaedic surgery by creating, evaluating, and disseminating new knowledge and by facilitating interaction among all orthopedic specialties. Founded in 1947 as the “American Bone and Joint Association,” ABJS membership is offered by invitation only to orthopaedic surgeons who have been certified by the American Board of Orthopaedic Surgery.

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