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Shao-Hsien Liu is leading an NIH-funded R21 examining how postoperative care management impacts caregivers of patients who had joint replacement surgery and whether such care differs by racial/ethnicity

Assistant Professor Shao-Hsien Liu PhD is leading an NIH-funded R21 study examining how postoperative care management impacts caregivers of patients who had joint replacement surgery and whether such care differs by racial/ethnicity. The study is entitled “Racial disparities in total joint arthroplasty (TJA) recovery.”

The Centers for Medicare and Medicaid Services, in an effort to control costs associated with joint replacement surgery (also known as total joint arthroplasty or TJA), implemented payment reform to fee-for-service payments. Payment reform dramatically changed the landscape of postoperative TJA care by decreasing both hospital length of stay and use of in-patient rehabilitation facilities while increasing reliance on informal caregivers for home-based care. Research in this area is sorely needed to assure favorable postoperative outcomes in the era of sweeping payment reforms.

Persistent racial disparities in TJA utilization and outcomes have been documented for three decades.
Black patients are more likely to experience complications, severe chronic pain, be readmitted to the hospital, and have higher mortality rates than white patients. This study leverages existing data from the 2015 National Health and Aging Trends Study (NHATS) replenishment cohort, which cross-links Medicare claims to longitudinal survey data collected from a nationally representative sample of Medicare beneficiaries and their caregivers (National Study of Caregiving [NSOC]). NHATS conducted face-to-face interviews (TJA - non-Hispanic Black: N=226; non-Hispanic White: N=1,160) to assess a wide array of disability predictors, patient-reported outcomes, and help received with daily activities. The aims of the proposed study are to:

1) examine racial disparities in the prevalence of postoperative care management (e.g., use of rehabilitation services, hours of care received) and correlates of postoperative outcomes (e.g., pain, disability, well-being, and unmet need) in persons undergoing TJA;
2) describe racial disparities characteristics (e.g., physical, psychosocial health, and caregiving support service used), involvement (e.g., health tasks performed), and information-seeking behavior; and
3) evaluate the extent to which racial disparities in TJA outcomes are mediated by modifiable factors such as postoperative care management and caregiver involvement.

Understanding root causes of health disparities in arthritis care and identifying remedies to reduce them is a research imperative (PA-18-159). Whether CMS payment reform will exacerbate or diminish pervasive racial disparities in TJA is unknown. This study will evaluate the care received post discharge from joint replacement surgery, the impact on the caregivers, and the extent to which this differs by race/ethnicity. The results will generate knowledge to inform novel strategies to reduce health disparities in arthritis care and to inform large-scale research efforts to reduce racial disparities in TJA outcomes.

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