Barrett, The Honors College Thesis/Creative Project Collection

A notable dilemma in the educational systems of current year is the lack of diversity in the faculty, administration, and curriculums. Diversity in education is colloquially understood to instill benefits in students that include development of sophisticated communication skills and heightened motivation, which may in turn have measurable benefits on health. In an effort to articulate the impact of introducing greater variegation into these systems and vocalize recommendations toward incorporating diversity into existing educational systems, the history of minority groups in schooling systems was analyzed, as were common health concerns for these communities. To this end, local students from Arizona State University were surveyed about their perceptions on diverse populations within their educational system. Moreover, these groups were also polled about how the messaging they receive about health and diversity may impact self-perceptions about their own health, as well as how applicable that messaging is with their own experiences.

Research Objective Social determinants of health (SDOH) are the conditions in one’s living environment that affect health, functioning, and quality of life. Total joint arthroplasty (TJA) is a surgical procedure to replace a damaged joint with an artificial joint. TJA complications include acute myocardial infarction, pneumonia, sepsis, surgical site bleeding, pulmonary embolism, or periprosthetic joint infection. Previous research demonstrates that Black race, Hispanic ethnicity and poverty were negatively associated with TJA outcomes in veterans. The goal of this mixed methods quality improvement study is to determine if SDOHs affect TJA complications at a health system in the Phoenix metropolitan area. Methodology For this study, records from patients who underwent hip or knee TJAs at any of the four system facilities between 2/2019-2/2020 were included. Demographics and clinical data were extracted from the electronic health record (EHR) via Midas+ Care Management with SDOH variables from case manager notes corresponding to food, utilities, housing and transportation insecurities, and interpersonal safety. Complications were identified using ICD-10 codes. SDOH for individuals with and without complications were compared. A multinomial logistic regression was performed in SPSS to identify significant variables. Semi-structured interviews with case managers (n=2), orthopedic surgeons(n=5), and primary care physicians (n=4) were performed to explore care team interactions with SDOH. Interview notes were coded and analyzed based on response frequency and themes. Results Of 2,520 patients who underwent TJA, 50 (1.98%) experienced a TJA complication. Of those, 38% screened positive for an SDOH. For those without a TJA complication, 27% screened positive for an SDOH (p=0.093). Most interview participants identified a correlation between socioeconomic status and surgical outcomes. They also recognized that language barriers for Spanish-speaking individuals and family involvement post-discharge are significant factors in TJA outcomes. Conclusions This single system mixed methods retrospective quality improvement study demonstrates that patients who screen positive for an SDOH are more likely to experience a TJA complication. We recommend that SDOH assessments be obtained for all patients undergoing TJA, be available to care teams, and be incorporated into care plans to improve outcomes.