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Shao-Hsien Liu studies racial disparities in total joint arthroplasty recovery

UMMS researcher probes higher rate among Black patients of complications, severe pain, hospital readmission and mortality after surgery

By Susan E.W. Spencer

UMass Medical School Communications

September 30, 2020
Shao-Hsien Liu, PhD

Racial disparities in utilization and outcomes of total joint arthroplasty, one of the most common surgical procedures performed in the United States, have persisted for 30 years, according to UMass Medical School researcher Shao-Hsien Liu, PhD. But little is known about what drives these disparities.

Dr. Liu, assistant professor of population & quantitative health sciences, a musculoskeletal epidemiologist with clinical experience as a physical therapist, recently received a $405,000, two-year grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases to study how postoperative care management following total joint arthroplasty, or TJA, may play a role in documented higher rates among Black patients of complications, severe pain, hospital readmission and higher overall mortality than among White patients.

Understanding the relationships between sociodemographic characteristics and modifiable preventable risk factors in the postoperative period was needed to improve care, Liu said.

“We hypothesize that disparities in postoperative care management, such as use of rehabilitation services and pain medications, partially explain why Black patients experience worse TJA outcomes than White patients,” he said. “Family caregiver involvement may diminish racial disparities in outcomes.”

The exploratory project looks at data from the 2015 National Health and Aging Trends Study (NHATS) replenishment cohort. It links Medicare claims to longitudinal survey data collected from a nationally representative sample of Medicare beneficiaries and their caregivers, called the National Study of Caregiving. The research enables a unique evaluation from patient and caregiver perspectives regarding postoperative outcomes and postoperative care management in patients with TJA.

The National Health and Aging Trends Study includes face-to-face interviews to assess a wide array of disability predictors, such as living arrangement; patient-reported outcomes, such as activities of daily living and quality of life; help received, whether household, medical or self-care; and insurance factors. NSOC provides information on caregiving activities and support services sought and used.

Liu explained that post-hospital care, often provided at home, has become an even larger component in recovery since the Center for Medicare and Medicaid Services implemented payment reform approximately five years ago. Hospital payments shifted to being based on a total episode of care for TJA, including hospital and post-hospital services, instead of fee-for-service payments for individual services of medical care provided.

“It is possible the patients may get discharged from the hospital a bit earlier compared with the previous practice,” Liu said. “We think it’s really important to understand care needs and outcomes not only from the patient perspective but also from the caregiver side. Because if we are shifting the care from the hospital or health care provider to the family, it will be important to know what they need to take care of their family members.”

An example he gave might be identifying if caregivers have access to helpful, understandable information.

“Hopefully, with the unique data set that we are going to use, we can generate fundamental information that can be used for some sort of intervention tools in the future, and then have larger scale intervention studies,” said Liu.