Evidence of disparities in health care is remarkably consistent across a range of diseases and health care services. Osteoarthritis (OA) and other rheumatic diseases are no exception. The greater severity of rheumatic diseases in a number of disadvantaged population subgroups suggests that there are disparities in access to care and/or in the actual delivery of care (i.e., how, or how well, individuals are managed over time). There is compelling evidence that some patients receive inadequate nonpharmacological and pharmacological OA care based on patient characteristics such as socioeconomic status (SES) or gender. Perhaps the most studied disparity in the rheumatic diseases is in total joint replacement (TJR). Despite a higher prevalence of disabling OA among vulnerable populations, disparities in the rates of use of TJR in appropriate and willing surgical candidates have been observed by sex, race/ethnicity/culture, and SES. Possible explanations for disparities in the quality of care in rheumatology including differential access to health care, patient preferences and physician bias will be explored. The equity-effectiveness loop framework will be presented as one way to evaluate disparities in rheumatological care and highlight the greatest barrier to equity. I will describe a study we did involving standardized patients, one that we dubbed “Operation Knee”, that provided some of the most conclusive evidence to date of a significant physician contribution to gender disparity in TKR utilization. An ongoing study to determine whether the source of the observed gender bias is based on implicit attitudes or unconscious bias using an implicit association test will be described.
Disclosure of Interest None Declared