Social Determinants and Timeliness of Total Knee Replacement A National Perspective

Project Summary The proposed R01 aims to augment data from the FORCE-TJR national Registry with radiographic readings, geospatial information and Medicare claims data to quantify timeliness of total knee replacement (TKR), and investigate the social determinants (SD) affecting timing of TKR. We propose 3 specific aims. Aim 1 applies validated appropriateness criteria to a representative sample of the FORCE-TJR registry patients to classify them as either premature or appropriate but with 5 different levels of functional disability. Aim 2 appends this sample with geospatial information (SD) about their environment and determine the effect of the SD factors on TKR utilization. Aim 3 determine the effect of the SD factors on improvement after surgery. We examine the effect of SD factors related to (1) the medical care environment (i.e., access to and practice patterns of medical care) and (2) the built environment (i.e., all of the physical parts of where we live and work (e.g., homes, buildings, streets, open spaces, and infrastructure)). Our project will be the first to examine timing of TKR at a national level, and will provide new knowledge regarding the association of the medical care and built environments with timeliness of TKR utilization. Our findings will also inform clinical and public policy interventions aimed at targeting TKR to those who would benefit most from the procedure, and add to evidence that would support the proposition that improvements to the environment could lead to an overall reduction in disability pertaining to knee osteoarthritis.