wow-inequalities/02-data/intermediate/wos_sample/424109407b3c86ed8871e551673c5f9e-bernstein-david-n./info.yaml

abstract: 'BackgroundIt is well documented that routinely collected patient

  sociodemographic characteristics (such as race and insurance type) and

  geography-based social determinants of health (SDoH) measures (for

  example, the Area Deprivation Index) are associated with health

  disparities, including symptom severity at presentation. However, the

  association of patient-level SDoH factors (such as housing status) on

  musculoskeletal health disparities is not as well documented. Such

  insight might help with the development of more-targeted interventions

  to help address health disparities in orthopaedic

  surgery.Questions/purposes(1) What percentage of patients presenting for

  new patient visits in an orthopaedic surgery clinic who were unemployed

  but seeking work reported transportation issues that could limit their

  ability to attend a medical appointment or acquire medications, reported

  trouble paying for medications, and/or had no current housing? (2)

  Accounting for traditional sociodemographic factors and patient-level

  SDoH measures, what factors are associated with poorer patient-reported

  outcome physical health scores at presentation? (3) Accounting for

  traditional sociodemographic factor patient-level SDoH measures, what

  factors are associated with poorer patient-reported outcome mental

  health scores at presentation?MethodsNew patient encounters at one Level

  1 trauma center clinic visit from March 2018 to December 2020 were

  identified. Included patients had to meet two criteria: they had

  completed the Patient-Reported Outcome Measure Information System

  (PROMIS) Global-10 at their new orthopaedic surgery clinic encounter as

  part of routine clinical care, and they had visited their primary care

  physician and completed a series of specific SDoH questions. The SDoH

  questionnaire was developed in our institution to improve data that

  drive interventions to address health disparities as part of our

  accountable care organization work. Over the study period, the SDoH

  questionnaire was only distributed at primary care provider visits. The

  SDoH questions focused on transportation, housing, employment, and

  ability to pay for medications. Because we do not have a way to

  determine how many patients had both primary care provider office visits

  and new orthopaedic surgery clinic visits over the study period, we were

  unable to determine how many patients could have been included; however,

  9057 patients were evaluated in this cross-sectional study. The mean age

  was 61 +/- 15 years, and most patients self-reported being of White race

  (83\% {[}7561 of 9057]). Approximately half the patient sample had

  commercial insurance (46\% {[}4167 of 9057]). To get a better sense of

  how this study cohort compared with the overall patient population seen

  at the participating center during the time in question, we reviewed all

  new patient clinic encounters (n = 135,223). The demographic information

  between the full patient sample and our study subgroup appeared similar.

  Using our study cohort, two multivariable linear regression models were

  created to determine which traditional metrics (for example,

  self-reported race or insurance type) and patient-specific SDoH factors

  (for example, lack of reliable transportation) were associated with

  worse physical and mental health symptoms (that is, lower PROMIS scores)

  at new patient encounters. The variance inflation factor was used to

  assess for multicollinearity. For all analyses, p values < 0.05

  designated statistical significance. The concept of minimum clinically

  important difference (MCID) was used to assess clinical importance.

  Regression coefficients represent the projected change in PROMIS

  physical or mental health symptom scores (that is, the dependent

  variable in our regression analyses) accounting for the other included

  variables. Thus, a regression coefficient for a given variable at or

  above a known MCID value suggests a clinical difference between those

  patients with and without the presence of that given characteristic. In

  this manuscript, regression coefficients at or above 4.2 (or at and

  below -4.2) for PROMIS Global Physical Health and at or above 5.1 (or at

  and below -5.1) for PROMIS Global Mental Health were considered

  clinically relevant.ResultsAmong the included patients, 8\% (685 of

  9057) were unemployed but seeking work, 4\% (399 of 9057) reported

  transportation issues that could limit their ability to attend a medical

  appointment or acquire medications, 4\% (328 of 9057) reported trouble

  paying for medications, and 2\% (181 of 9057) had no current housing.

  Lack of reliable transportation to attend doctor visits or pick up

  medications (beta = -4.52 {[}95\% CI -5.45 to -3.59]; p < 0.001),

  trouble paying for medications (beta = -4.55 {[}95\% CI -5.55 to -3.54];

  p < 0.001), Medicaid insurance (beta = -5.81 {[}95\% CI -6.41 to -5.20];

  p < 0.001), and workers compensation insurance (beta = -5.99 {[}95\% CI

  -7.65 to -4.34]; p < 0.001) were associated with clinically worse

  function at presentation. Trouble paying for medications (beta = -6.01

  {[}95\% CI -7.10 to -4.92]; p < 0.001), Medicaid insurance (beta = -5.35

  {[}95\% CI -6.00 to -4.69]; p < 0.001), and workers compensation (beta =

  -6.07 {[}95\% CI -7.86 to -4.28]; p < 0.001) were associated with

  clinically worse mental health at presentation.ConclusionAlthough

  transportation issues and financial hardship were found to be associated

  with worse presenting physical function and mental health, Medicaid and

  workers compensation insurance remained associated with worse presenting

  physical function and mental health as well even after controlling for

  these more detailed, patient-level SDoH factors. Because of that,

  interventions to decrease health disparities should focus on not only

  sociodemographic variables (for example, insurance type) but also

  tangible patient-specific SDoH characteristics. For example, this may

  include giving patients taxi vouchers or ride-sharing credits to attend

  clinic visits for patients demonstrating such a need, initiating

  financial assistance programs for necessary medications, and/or

  identifying and connecting certain patient groups with social support

  services early on in the care cycle.'
affiliation: 'Tobert, DG (Corresponding Author), Massachusetts Gen Hosp, Dept Orthopaed
  Surg, 55 Fruit St, Boston, MA 02114 USA.

  Bernstein, David N.; Lans, Amanda; Karhade, Aditya V.; Heng, Marilyn; Schwab, Joseph
  H.; Tobert, Daniel G., Harvard Med Sch, Massachusetts Gen Hosp, Dept Orthopaed Surg,
  Boston, MA USA.

  Bernstein, David N.; Karhade, Aditya V., Harvard Combined Orthopaed Residency Program,
  Boston, MA USA.

  Lans, Amanda, Univ Utrecht, Univ Med Ctr Utrecht, Dept Orthopaed Surg, Utrecht,
  Netherlands.

  Bernstein, David N.; Poolman, Rudolf W., Leiden Univ, Leiden Univ Med Ctr, Dept
  Orthopaed Surg, Leiden, Netherlands.

  Tobert, Daniel G., Massachusetts Gen Hosp, Dept Orthopaed Surg, 55 Fruit St, Boston,
  MA 02114 USA.'
author: Bernstein, David N. and Lans, Amanda and Karhade, Aditya V. and Heng, Marilyn
  and Poolman, Rudolf W. and Schwab, Joseph H. and Tobert, Daniel G.
author-email: 'bernsteindavidn@gmail.com

  alans@mgh.harvard.edu

  akarhade@partners.org

  mheng@mgh.harvard.edu

  namloop@gmail.com

  jhschwab@mgh.harvard.edu

  dtobert@mgh.harvard.edu'
author_list:
- family: Bernstein
  given: David N.
- family: Lans
  given: Amanda
- family: Karhade
  given: Aditya V.
- family: Heng
  given: Marilyn
- family: Poolman
  given: Rudolf W.
- family: Schwab
  given: Joseph H.
- family: Tobert
  given: Daniel G.
da: '2023-09-28'
doi: 10.1097/CORR.0000000000002446
eissn: 1528-1132
files: []
issn: 0009-921X
journal: CLINICAL ORTHOPAEDICS AND RELATED RESEARCH
keywords-plus: 'SYMPTOM SEVERITY; LUMBAR DISC; CARE; DISADVANTAGE; DISPARITIES;

  ETHNICITY; SURGERY; METRICS; RACE'
language: English
month: MAY
number: '5'
number-of-cited-references: '39'
orcid-numbers: 'Poolman, Rudolf/0000-0003-3178-2247

  Bernstein, David/0000-0002-1784-3288'
pages: 912-921
papis_id: f7275c460c4223280230a1352722331a
ref: Bernstein2023aredetailed
researcherid-numbers: 'Bernstein, David N./AAL-2777-2021

  Poolman, Rudolf/AAM-7815-2020

  '
times-cited: '2'
title: Are Detailed, Patient-level Social Determinant of Health Factors Associated
  With Physical Function and Mental Health at Presentation Among New Patients With
  Orthopaedic Conditions?
type: article
unique-id: WOS:000975638800017
usage-count-last-180-days: '0'
usage-count-since-2013: '0'
volume: '481'
web-of-science-categories: Orthopedics; Surgery
year: '2023'