RED KARD: Reducing Disparities in Knee Arthroscopy for Adolescents - PROJECT SUMMARY The purpose of this K23 proposal is to facilitate Dr. Neeraj Patel’s development into an independent surgeon scientist who will partner with communities, generate community-centered input, and design and implement interventions to reduce inequities in pediatric sports medicine. Hundreds of thousands of youth athletes require surgery for knee injuries annually. The incidence of operative knee injuries has skyrocketed, but surgery can be delayed due to late recognition and barriers, such as insurance, language, and difficulty navigating the healthcare system. Delays may have lifelong effects, including arthritis, persistent instability, poor patient reported outcomes, and reoperation. There is little patient-centered research on barriers to orthopaedic care, and none on interventions to reduce disparities in pediatric sports medicine. To accomplish his long-term goals, Dr. Patel requires training in community engaged research (CEnR), qualitative methods, and implementation science. He will achieve these training goals through a comprehensive career development plan that includes strong mentoring, focused didactics, growing collaborations, and experiential training. This will guide him towards national expertise in disciplines where few orthopaedic surgeons have any background. His primary mentor is Dr. Rinad Beidas, an international leader in implementation science with extensive record of federally funded community research and mentorship. The mentoring team also includes a diverse, multidisciplinary group of researchers with complementary expertise: Drs. Namratha Kandula (CEnR and intervention design), Matthew Davis (pediatric CER and population health research), and Julie Johnson (qualitative methods). Dr. Patel’s development will be bolstered by the robust resources of Lurie Children’s Hospital and Northwestern University. The proposed study will focus on Hispanic children, a growing population nationally and 38% of the Chicago’s children, who are at increased risk of delayed knee surgery and its sequelae compared to white, non-Hispanic patients. The overall objectives are to identify barriers to timely knee surgery in Hispanic athletes and develop an intervention to implement evidence on expedient treatment. Under the lens of the Health Equity Implementation Framework, the specific aims are to: (1) identify barriers and facilitators to timely care of knee injuries for Hispanic high school athletes; (2) design an evidence- based, culturally-tailored intervention for Hispanic athletes, families, and coaches to reduce delays in evaluation of acute knee injuries via user-centered principles; and (3) evaluate feasibility, acceptability, and appropriateness of the culturally-tailored intervention in a pilot study of Hispanic youth soccer leagues. The proposed aims will drive creation of a future community trial of a culturally-tailored intervention, which will be the basis for R03 and R01 funding applications. In the process, Dr. Patel will become an expert in CEnR, qualitative methods, and implementation science, establishing him as one of the only orthopaedic surgeons conducting health equity CER and a resource for others seeking to address orthopaedic disparities.
