Disparities in delays in care and patient treatment: A retrospective review of one outpatient orthopedic clinic

Background: This study aims to describe disparities in treatment and delays in care at one orthopaedic resident run clinic. Methods: Adult patients at one orthopaedic clinic between January 2018-December 2021 treated for hip or knee arthritis/pain screened by ICD-10 codes were retrospectively reviewed. Characteristics were summarized by treatment and delay status, and social determinants of health zip-code level data extrapolated from U.S. Census Bureau and American Community Data Survey, 5-yr Estimates 2018-2022. Analyses were conducted using Microsoft Excel. Student’s t-tests for continuous variables and Pearson’s chi-squared test or Fisher’s exact test for categorical variables were utilized. P <0.05 was considered significant. Results: Race, gender and follow up varied between patients treated surgically versus non-surgically. Conservative management varied across race, surgical status, and poverty status. 44 patients had documented delays in care. Of those treated surgically, average encounters were 4.1±4.1 without delay, and 8.0±4.2 with delay ( P <0.001). Nonwhite surgical patients were more likely to have documented delays (0.03% vs. 0.04%, P <0.001). White patients had significantly higher median household income, lower poverty, higher education, higher employment, and lower percentage without healthcare. Low poverty status patients were more frequently treated surgically ( P <0.001), with less time to surgery ( P 0.005); however, were more likely to have documented delays in care (8.1% vs. 4.4%, P 0.01). Conclusion: Race, ethnicity and poverty status play a role in delays in care and orthopedic treatment.