Jessica Clymer SUMR 2011 Scholar

REPAIR and ACTION Studies with Said Ibrahim, MD, MPH

Background information Project overview Methods Significance/Aims My role What I learned Thank yous!

The clinical issue Arthritis or rheumatism is the most common

cause of disability among US adults (17.5% of all disability)

Key findings from previous studies Attitudes toward treatment options for

osteoarthritis vary by race Patient preference varies by race and is a

function of surgical outcome expectations Patient race is not a significant predictor of

surgical recommendation at the orthopedic level

Joint Replacement surgery is an effective treatment option for osteoarthritis More than 90% report improvement in pain/function Less than 1% mortality rate Joint prosthesis lasts up to 20 years .5 million joint replacement surgeries are done

annually State knee replacement rate is up 45% between 2000-

2004

Marked variation in the utilization of knee/hip joint replacement in the African American community

Patient factors are considered to be the cause in variation of treatments

Consider patient factors: Attitudes toward joint replacement Knowledge about the treatment Patient preferences Surgical outcome expectancy

Looking to see how an educational intervention affects patients’ decisions about their knee pain.

Recruiting African American patients over the age of 50 with a history of osteoarthritis. Screened for exclusion factors and used the WOMAC

scale to ensure severe knee pain assesses the pain, joint stiffness, physical, social & emotional

function of a person with osteoarthritis in determining the overall level of disability.

Patients undergo a baseline phone interview.

For the REPAIR study, they are met at their primary care appointment for an educational intervention.

For the ACTION study, they are met at their orthopedic specialist appointment for an educational intervention.

Educational intervention is done when a staff member meets the patient before his/her appointment, and it consists of a DVD explaining knee replacement surgery.

For REPAIR patients, they also have a discussion after the video to answer questions.

Patients in the control group receive a pamphlet prior to their appointments that discusses different treatment options for knee osteoarthritis other than knee replacement surgery.

For the REPAIR study, patients complete a 2-week, 3-month and 1-year follow up phone interview about their views on their knee pain and knee replacement surgery. 1 year after their educational intervention, we

will look into their medical records.

For ACTION study, we look into their records after six months, and do a 1-year follow up phone interview.

More utilization of an effective treatment Potential opportunity to improve the quality

of life for minority patients with osteoarthritis

Potential opportunity to improve management of other deadly co morbidities

Model for understanding how education shapes elective treatment decisions

Began the summer doing quality assurance Learned how to do follow-up interviews Eventually learned baseline and screening

interviews Helped with recruitment: mailing and screening

patients from the list of potential participants from UPHS (Penn Care, Presbyterian, Ralston, Penn Family Care)

Tracking and entering data Phone surveys Recruitment strategies: working within UPHS to find patients, sending

letters and following up with phone calls, advertising with Metro and SEPTA, expanding to the VA and possibly other outside

providers

IRB Effective time management! Job application process

Principal investigator and my mentor for the SUMR program, Dr. Said Ibrahim

My wonderful TEAM of mentors: Heather, Brandon, Ro, Becky, Erik, Emma, Craig

Joanne Levy, Lissy Madden and LDI Staff Fellow scholars