Studies from four areas of musculoskeletal health care disparities were reviewed to determine the root causes of the disparities and gain insight into measurable interventions. The areas of musculoskeletal health were total joint arthroplasty, amputation for patients with diabetes, rehabilitation of and impairment in patients with stroke, and morbidity associated with unintentional injuries. The Jenkins Model on Health Disparities was used to investigate and rank the contributing causes (socioeconomic status, sociocultural beliefs, racism, biology) of the health care disparities. No single root cause was found for any of the conditions. Thus, all contributing factors must be considered when planning meaningful interventions.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Although the health status of all Americans has improved substantially in the past century, gender and ethnic disparities still persist. Gender and ethnic disparities in diabetic foot management and amputations are an important but largely ignored issue in musculoskeletal health care. QUESTIONS/PURPOSES: Our purposes were to (1) clarify where we are now, (2) describe ways to get where we need to go, and (3) suggest solutions for how we get there, with respect to gender and ethnic disparities in diabetic foot management and amputations. WHERE ARE WE NOW?: Studies investigating socioeconomic, cultural, racial, and biologic contributing factors on gender and ethnic musculoskeletal healthcare disparities have found no single root cause. Studies into disparities in diabetic foot management and amputation have discordant methodologies and most are retrospective. Effective intervention strategies to eliminate these disparities are nonexistent. WHERE DO WE NEED TO GO?: The orthopaedic leadership should lead the movement to create a clearly defined strategy and assist young investigators to gain access to large datasets to study this problem. Orthopaedic specialty society leaders should help to create valid outcome tools, especially on peripheral vascular disease and amputations. HOW DO WE GET THERE?: The working group proposed a three-pronged strategy of education, research, and advocacy to help address this problem.
Clinical Orthopaedics and Related Research 12/2010; 469(7):1967-70. DOI:10.1007/s11999-010-1742-5 · 2.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Advances in medicine in the past century have resulted in substantial reductions in morbidity and mortality in the United States. However, despite these improvements, ethnic and racial minorities continue to experience health status and healthcare disparities. There is inadequate national awareness of musculoskeletal health disparities, which results in greater chronic pain and disability for members of ethnic and racial minority groups. The Sullivan Commission concluded in 2004 the inability of the health professions to keep pace with the US population is a greater contributor to health disparities than lack of insurance. WHERE ARE WE NOW?: While African Americans, Hispanic Americans, and Native Americans constitute more than one-third of the US population, they make up less than 10% of physicians, dentists, and nurses and less than 4% of orthopaedists in the United States. WHERE DO WE NEED TO GO?: Increasing the representation of women and ethnic and racial minorities in orthopaedics will help to increase trust between patients and their providers and will improve the quality of these interactions by enhancing culturally and linguistically appropriate orthopaedic care. HOW DO WE GET THERE?: Pipeline enrichment programs along the educational spectrum are important in the academic preparation of underrepresented minorities. Collaborations between health professions schools and postsecondary educational institutions will increase awareness about careers in the health professions. Ongoing mentorships and career counseling by orthopaedists should enhance the interest of underrepresented minority students in careers as orthopaedists.
Clinical Orthopaedics and Related Research 07/2011; 469(7):1809-12. DOI:10.1007/s11999-010-1708-7 · 2.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Many authors report racial and ethnic disparities in total joint arthroplasty. The extent and implications, however, are not fully understood. QUESTIONS/PURPOSES: Our purposes in this breakout session were to (1) define "Where are we now?"; (2) outline "Where do we need to go?"; and (3) generate a plan for "How do we get there?" in addressing issues of racial disparity and total joint arthroplasty. WHERE ARE WE NOW?: Blacks and some other ethnic minorities have a greater incidence of arthritis and chronic disability than the population in general. Blacks have a lower use of total joint arthroplasty for a variety of reasons, including patient trust, perceived limited satisfaction with results by peers, varying knowledge about total joint arthroplasty, and concerns about pain associated with these procedures. Current data, however, are insufficient to clearly define the magnitude and nature of musculoskeletal disparities. WHERE DO WE NEED TO GO?: We need to better define the magnitude and nature of racial disparities to best design and implement research questions and studies and target areas for improvement. We should define geographic and provider variation that lead to the differences in use that has been observed in total joint arthroplasty. HOW DO WE GET THERE?: A profession-wide emphasis and focus on disparities needs to be developed with other medical specialties and national organizations to advocate for changes to better define and address racial disparities. Partnerships with organizations and/or investigators that can gain access to relevant databases should be encouraged. Special attention to disparities and manuscript reviewing and editing is essential.
Clinical Orthopaedics and Related Research 07/2011; 469(7):1886-90. DOI:10.1007/s11999-011-1897-8 · 2.77 Impact Factor
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