The leading cause of disability in the United States is osteoarthritis. There is no known cure. Consequently, osteoarthritis is managed with a variety of treatments to reduce disability, improve function, and alleviate symptoms. When conservative treatments fail, surgical intervention is indicated. The most effective surgical option for moderate to severe osteoarthritis in the knee or hip is total joint replacement (TJR). TJR is often considered appropriate in cases where other non-surgical treatments have not brought adequate relief. TJR in the management of end-stage osteoarthritis is widely utilized and is considered the fastest growing elective surgery in the nation, if not the world.

Although TJR is highly successful at treating advanced kip or knee osteoarthritis, there is substantial evidence that disparities exist in TJR utilization in non-VA settings, with racial and ethnic disparities being the most documented. This report compares what is known about disparities in TJR in the VA context with disparities in non-VA settings.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • BACKGROUND
  • METHODS
  • DATA SYNTHESIS
  • PEER REVIEW
  • RESULTS
  • ABBREVIATIONS TABLE
• INTRODUCTION
  • BACKGROUND
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • RATING THE BODY OF EVIDENCE
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • DESCRIPTION OF EVIDENCE
  • KEY QUESTION #1 What is the evidence about the existence and magnitude of disparities in joint replacement surgery in VA? How does this compare to published studies from non-VA US populations?
  • KEY QUESTION #2 What is the evidence about the patient level, provider level, and system level factors that contribute to disparities in joint replacement surgery in VA? How does this compare to published studies from non-VA populations?
  • KEY QUESTION #3 What is the evidence regarding VA or non-VA interventions to reduce disparities in joint replacement surgery?
• SUMMARY AND DISCUSSION
  • SUMMARY OF EVIDENCE BY KEY QUESTION
  • LIMITATIONS
  • RECOMMENDATIONS FOR FUTURE RESEARCH
• REFERENCES
• APPENDIX A SEARCH STRATEGY
• APPENDIX B STUDY SELECTION FORM
• APPENDIX C DATA EXTRACTION FORM
• APPENDIX D NEWCASTLE OTTAWA SCALE CRITERIA USED IN QUALITY ASSESSMENT
• APPENDIX E PEER REVIEW COMMENTS/AUTHOR RESPONSES
• APPENDIX F EVIDENCE TABLES

Medical Editor: Mary E Vaiana, PhD

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, West Los Angeles VA Medical Center, Los Angeles, CA, Paul G. Shekelle, MD, PhD, Director

Suggested citation:

Gellad WF, Maggard MA, Miake-Lye IM, Shekelle PG. A Comparison of Joint Replacement Disparities in VA and Non-VA Settings: A Systematic Review. VA-ESP Project #05-226; 2011

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the West Los Angeles VA Medical Center, Los Angeles, CA funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.