# Racial disparities in total joint arthroplasty (TJA) recovery

> **NIH NIH R21** · UNIV OF MASSACHUSETTS MED SCH WORCESTER · 2020 · $221,100

## Abstract

PROJECT SUMMARY/ABSTRACT
To control costs in response to the looming exponential TJA demand, the Centers for Medicare and Medicaid
Services has implemented payment reform to hold hospitals accountable by using “episodes of care” rather than
fee-for-service payments. Payment reform has dramatically changed the landscape of postoperative TJA care
by decreasing both hospital length of stay and use of in-patient rehabilitation facilities while increasing reliance
on informal caregivers for home-based care. Contemporary research on postoperative care management and
caregiver characteristics in relation to postoperative outcomes among patients who undergo TJA is lacking, but
are sorely needed to assure favorable postoperative outcomes in the era of sweeping payment reforms.
Persistent racial disparities in TJA utilization and outcomes have been documented for three decades. For those
undergoing TJA, black patients are more likely to experience complications, severe chronic pain, be readmitted,
and have higher mortality rates than white patients. The U.S. Department of Health and Human Services Action
Plan to Reduce Racial and Ethnic Health Disparities targets arthritis for the development, examination, and
implementation of strategies for evidence-based interventions in racial minority populations. This study will
leverage existing data from the 2015 National Health and Aging Trends Study (NHATS) replenishment cohort,
which cross-links Medicare claims to longitudinal survey data collected from a nationally representative sample
of Medicare beneficiaries and their caregivers (National Study of Caregiving [NSOC]). NHATS conducted face-
to-face interviews (TJA - non-Hispanic Black: N=226; non-Hispanic White: N=1,160) to assess a wide array of
disability predictors, patient-reported outcomes, and help received with daily activities. The aims of the proposed
study are to: 1) examine racial disparities in the prevalence of postoperative care management (e.g., use of
rehabilitation services, hours of care received) and correlates of postoperative outcomes (e.g., pain, disability,
well-being, and unmet need) in persons undergoing TJA; 2) describe racial disparities in TJA patient caregivers’
characteristics (e.g., physical, psychosocial health, and caregiving support service used), involvement (e.g.,
health tasks performed), and information-seeking behavior; and 3) evaluate the extent to which racial disparities
in TJA outcomes are mediated by modifiable factors such as postoperative care management and caregiver
involvement. Understanding root causes of health disparities in arthritis care and identifying remedies to reduce
them is a research imperative (PA-18-159). Whether CMS payment reform will exacerbate or diminish pervasive
racial disparities in TJA is unknown. The proposed work will identify modifiable drivers of racial disparities in TJA
postoperative care management. This exploratory project is an important first step to inform large-scale research
e...

## Key facts

- **NIH application ID:** 9874877
- **Project number:** 1R21AR076641-01
- **Recipient organization:** UNIV OF MASSACHUSETTS MED SCH WORCESTER
- **Principal Investigator:** Shao-Hsien Liu
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $221,100
- **Award type:** 1
- **Project period:** 2020-09-10 → 2022-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9874877

## Citation

> US National Institutes of Health, RePORTER application 9874877, Racial disparities in total joint arthroplasty (TJA) recovery (1R21AR076641-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9874877. Licensed CC0.

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