Racial, ethnic disparities persist in guideline-concordant hip fracture care
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Key takeaways:
- Patients from historically underrepresented groups were less likely to receive guideline-concordant care vs. white patients.
- White patients also had greater benefits of standardized hip fracture programs.
Published results showed non-Hispanic white patients were more likely to receive guideline-concordant hip fracture care and also disproportionately benefited from their care vs. patients from historically underrepresented groups.
“It was expected that these programs would more uniformly reduce disparities, yet
our findings indicate that while [standardized hip fracture programs] SHFPs improve care quality overall, they also inadvertently widen the gap between racial and ethnic minority patients and their non-Hispanic white counterparts,” Christian A. Péan, MD, MS, orthopedic trauma surgeon at Duke Health, told Healio. “This suggests that while SHFPs are beneficial, they are not a panacea for the deep-rooted inequities in health care delivery.”
Péan and colleagues performed a cross-sectional study analyzing data from 62,194 patients aged 65 years or older with hip fractures undergoing surgical fixation in the American College of Surgeons National Surgical Quality Improvement Program Targeted Hip Fracture Database from 2016 to 2021.
Researchers categorized patients by racial and ethnic background to compare risk differences between non-Hispanic white patients and American Indian or Alaska Native, Asian, Black, Native Hawaiian or Pacific Islander, multiple race and Hispanic patients.
Outcomes measured included weight-bearing as tolerated on postoperative day 1, venous thromboembolism prophylaxis, bone-protected medication and the presence of SHFPs.
According to the study results, patients from historically underrepresented groups had a lower probability of receiving postoperative bone-protective medication and weight-bearing as tolerated on postoperative day 1 compared with non-Hispanic white patients.
Both groups were more likely to receive guideline-concordant care if their institution featured an SHFP, according to the study. However, Péan and colleagues found non-Hispanic white patients enjoyed greater benefits of a SHFP compared with patients from historically underrepresented groups.
“Addressing these disparities is not just a moral mandate but also an economic imperative as we transition toward population health approaches and value-based contracting,” Péan said. He added, “This study is part of a long line of wake-up calls, highlighting the critical need for a thoughtful, longitudinal care paradigm for hip fracture patients that prioritizes equitable outcomes.”
He added, “We plan to investigate more granular factors, including geographic data, rates of primary care follow-up, and the influence of social drivers of health, which may offer high-yield opportunities to enhance outcomes and contain costs in hip fracture care.”
Perspective
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The manuscript “Racial and ethnic disparities in providing guideline concordant care after hip fracture surgery” represents an important cog in the effort to understand and effect improvement in racial and ethnic patient outcomes following orthopedic surgical procedures. The study underscores the existence of disparities in patients undergoing hip fracture surgery despite a standardized care protocol. With the implementation of guidelines to promote postoperative venous thromboembolic prophylaxis, early weight-bearing and bone protective medications, non-Hispanic white patients were more likely to receive guideline concordant care than their racial and ethnic minority counterparts. Minority patients often encounter surgical delays, longer hospital stays and a burden of medical comorbidities.
This study is important demonstrating that well-intentioned guidelines may improve care overall, but minority patients are less impacted. These guidelines may certainly provide a minimum standard of care but fail to address existing medical comorbidities and the impact of socioeconomic status which burden a disproportionate number of racial and ethnic minority patients. As we seek to provide equitable outcomes across to all patients, this type of investigation is important as it shows the impact of our interventions is sometimes uneven and we must be especially insightful in caring for these vulnerable populations.
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