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 efforts to reduce racial disparities in TJA outcomes.

PROJECT NARRATIVE Joint replacement surgery is common in patients with arthritis. Yet, we know little about postoperative care management and the impact on the caregivers in patients who had joint replacement surgery and whether such care differs by racial/ethnicity. This study will evaluate the care received post discharge from joint replacement surgery, the impact on the caregivers, and the extent to which this differs by race/ethnicity. The results will generate knowledge to inform novel strategies to reduce health disparities in arthritis care.