The proposed project represents the next phase in a trajectory of research ultimately designed to eliminateracial disparities in the utilization of knee joint replacement - an effective treatment option for moderate tosevere knee OA. The current study is designed to identify the modifiable, patient-level socio-cultural andclinical factors that may contribute to the underutilization of elective knee joint replacement by African-Americans (AA) with knee OA. Numerous studies utilizing a variety of clinical and administrative databaseshave documented the existence of racial/ethnic disparities in the utilization of joint replacement in OAmanagement. For example, African-Americans are reported to be two to five times less likely than whitepatients to receive joint replacement for lower extremity osteoarthritis. Our research team conducted one ofthe first studies to explore the reasons why AA and white patients differ in their utilization of jointreplacement. We found that, compared to white patients, AA patients are less willing to consider jointreplacement even when clinically indicated and recommended by a physician. However, the specific socioculturaland clinical factors that impact patient willingness to consider joint replacement as a treatment optionremain unknown. The short-term goa/of this proposal is to identify socio-cultural and clinical determinants ofpatient willingness. Patient willingness will be assessed in this proposal in two ways: (1) use of a single-itemwillingness question, 2) assessment of willingness-to-pay, a widely used health economic measure ofcontingent valuation. The long-term goal is to apply the knowledge gained from this proposal to develop andtest a patient-centered intervention to eliminate racial disparity in the utilization of joint replacement. Thecentral hypothesis of this proposal is that AA and white patients with knee OA differ in their willingness toundergo joint replacement because of socio-cultural and clinical factors that vary by race. The rationale isthat by understanding the relationship between these socio-cultural and clinical factors and patientwillingness to consider joint replacement as treatment option, we will be able to identify modifiable factors forintervention. Our proposal is innovative because it seeks to identify modifiable attitudinal-based socioculturaland clinical variables that shape patient willingness, which will pave the way for the development of apatient-centered intervention to reduce this disparity.
The specific aims of this proposal are: 1) To examinedifferences between AA and white patients with knee OA in willingness to consider knee joint replacement.2) To examine the relationship between socio-cultural factors and patient willingness to consider jointreplacement. 3) To examine how demographic, socio-cultural, and clinical factors mediate the relationshipbetween race and patient willingness. 4) To examine the relationship between patient willingness andreferral to orthopedic care for knee OA (secondary aim).
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