Nationwide Study Shows Disparities in Outpatient Care for Common Orthopaedic Problems

    Racial/ethnic minorities people with low incomes, and other groups are less likely to receive office-based care for common musculoskeletal conditions, according to a national study published online ahead of print by Clinical Orthopaedics and Related Research.

    Some of the same characteristics are linked to higher use of more-expensive emergency department (ED) care for orthopaedic conditions, according to the new research from Case Western Reserve University School of Medicine, Cleveland. “It is imperative for orthopaedic surgeons to continue to collaborate with policy makers to create targeted interventions that improve access to and use of outpatient orthopaedic care to reduce healthcare expenditures,” the researchers write.

    The study included data on 63,514 patients who had received office-based or ED care for common orthopaedic conditions between 2007 and 2015, drawn from the nationally representative Medical Expenditure Panel Survey. The study focused on 8 categories of non-emergent musculoskeletal conditions:

    • Osteoarthritis (40%, n=25,200)
    • Joint derangement (0.5%, n=285)
    • Other joint conditions (43%, n=27,499)
    • Muscle or ligament conditions (6%, n=3726)
    • Bone or cartilage conditions (8%, n=5035)
    • Foot conditions (1%, n=585)
    • Fractures (7%, n=4189)
    • Sprains or strains (18%, n=11,387)

    The study did not include spinal disorders, which can be treated by either neurosurgeons or orthopaedic surgeons.

    Several sociodemographic factors were linked to lower use of office-based care for musculoskeletal conditions. After adjustment for other characteristics, black and Hispanic patients were about 20% less likely to receive outpatient care compared with white patients.

    Use of outpatient orthopaedic care was also lower for Americans with household incomes below the federal poverty line, without at least a high school education, and without private insurance (either on public insurance or uninsured). Instead, these patients were more likely to receive ED care for non-emergent musculoskeletal conditions. Hispanic patients also were more likely to receive ED care, although black patients were not. For most of the 8 conditions studied, expenditures were significantly higher for ED care than for office-based care.

    There are well-documented disparities in healthcare use in the US. Musculoskeletal disorders are a major health burden, affecting more Americans than either cardiovascular or respiratory disease and accounting for more than $162 billion in healthcare spending per year, based on data for 2012 to 2014.

    Office-based care is thought to be the most appropriate site of care for common musculoskeletal conditions. The new study is one of the first to link specific sociodemographic factors to disparities in the use outpatient orthopaedic care.

    Multiple factors may contribute to the observed disparities, including differences in health literacy, beliefs about health and disease, and lack of social support and resources to recognize diseases and make informed decisions. “[O]rthopaedic surgeons should focus on improving communication with patients of all backgrounds to help them identify musculoskeletal symptoms that warrant office-based orthopaedic care versus ED care,” the researchers concluded.


    Rabah NM, Knusel KD, Khan HA, Marcus RE. Are there nationwide socioeconomic and demographic disparities in the use of outpatient orthopaedic services? Clin Orthop Relat Res. 21 February 2020. doi: 10.1097/CORR.0000000000001168. [Epub]