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Improving hip surgery access and outcomes
What problem was studied?
Total hip replacement (THR) surgery can dramatically reduce pain and improve
function in people with debilitating arthritis. Yet, recent data confirms that
significant barriers exist that affect access to and the quality and outcomes of
this surgery. There are lower surgery rates among minority populations, who tend
to have greater disability. And despite recent research documenting that there
are much lower complication and death rates when the surgery is done in an
experienced hospital, about 25% of THR surgeries are done in hospitals with a
low volume of such surgeries. One recently published study was aimed at learning
more about why some people elect to use a low-volume hospital and who would be
most affected by policies that would restrict THR to high-volume centers.
Arthritis Foundation-funded researcher
involved in the study: Jeffrey N. Katz, MD, MSc, Brigham and Women’s Hospital,
Harvard Medical School, Boston, supported by an Arthritis Foundation Clinical
Science Grant
What was done in the study?
Patients who had undergone total hip replacement surgery in 1995 were
identified through Medicare claims data. A random sample of these patients,
representing multiple states and both low and high-volume hospitals, were
invited to participate in a written or phone survey. The survey asked about
demographic characteristics, reasons for hospital choice and reported functional
status 3 years post-surgery. The patients’ medical records were also reviewed.
What were the study results?
The study found that the use of low-volume hospitals (defined as 12 or less
primary THR surgeries per year) was associated with rural residency, low income
or education level and preference for a convenient location. The researchers
concluded that policies that restrict THR to high-volume centers would
preferentially affect older, poor, less-educated rural patients—which could
further widen the existing disparities in surgery rates. The study also found
that many patients reported that their primary care physician influenced their
choice of hospital. This finding suggests that both patients and their referring
physicians should be educated about differences in outcomes between high and
low-volume hospitals.
What’s the relevance to people with arthritis?
Such research furthers our understanding about the barriers to quality care and
strategies for improvement. The findings also warn that efforts to regionalize
care to centers of excellence must be undertaken carefully to avoid reducing
utilization of THR by the vulnerable patients that are already underserved.
Senior author Dr. Jeffrey Katz comments, "In our enthusiasm for reducing
complication rates, we do not wish to widen racial and ethnic disparities in use
of total hip replacement."
Source: Arthritis and Rheumatism
(Arthritis Care and Research), October 15, 2004
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15478142
  
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