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Large Joints Feature

Source: Wikimedia Commons and Capt. David Murphy

Orthopedic Registry Calls for Good Citizenship to Improve Patient Care

Tracey Romero • Mon, April 10th, 2017

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In today’s medical landscape, data collection and analysis are crucial to creating quality benchmarks that improve patient care, but not all hospitals, ambulatory surgery centers (ASCs) and surgeons have the necessary access to valuable information like national data on patient outcomes, complication rates and interventions. That is where the American Joint Replacement Registry, the official registry of the American Association of Hip and Knee Surgeons, comes in.

The American Joint Replacement Registry (AJRR) is dedicated to collecting hip and knee total joint replacement data nationwide to help hospitals, ASCs and surgeons improve the quality of care. The registry was founded in 2009 and started collecting data in 2013 because of the success of joint replacement registries in other countries, including Sweden, the United Kingdom and Australia, which helped improve the healthcare for patients at a nationwide level.

Daniel J. Berry, M.D., chair of the American Joint Replacement Registry’s Board of Directors Executive Committee and past president of The Hip Society, told OTW that “AJRR came about because people in the orthopedic community felt we could improve care through data collection. The registry allows hospitals, ASCs and surgeons to get feedback on how they are doing compared to national norms and gives them the opportunity to collect their data. Many hospitals don’t have that ability.”

Berry said that 1,000,000 joint replacements are now currently entered in the registry and more than 6,300 surgeons and almost 1,000 hospitals are enrolled, but there is still work to be done.

“There is a good citizenship element needed to dramatically improve patient outcomes. To be most effective the registry requires everyone to participate,” he said.

How It Works

Participation in the registry is free, but access to the Demand Reporting & Electronic Dashboard System does require a small subscription fee. The subscription fee includes one authorized user access to unlimited reporting and national comparison and benchmarking of the data submitted. The fee also includes a patient-reported module so participant facilities can implement and administer survey instruments to patients as well.

Without a subscription hospitals still receive a standard yearly report on their data which includes comparison to national benchmarks as well as inclusion in the AJRR Annual Report with national data collection statistics.

The registry collects three categories of data:

Level I: Basic patient demographics and type of prosthesis as well as information on who did the surgery and what hospital it took place at

Level II: Information on patient risk factors, comorbidities and complications from surgery

Level III: Patient-reported outcome scores

“Individual surgeons offices often need to be enlisted to gather Level II & III data, to determine how patients are doing in follow-up,” Berry said.

“The registry also collects revision rates and data on how different comorbidities effect outcomes,” he said. “In our annual report we provide detail analysis of demographics, frequency of type of implant, and most common reason for revision.”

Berry said that they are also working with the Centers for Medicare & Medicaid Services (CMS) to gain access to claims data from the federal government, which allows them to know what happened to patients entered into the registry, but who ended up having surgery at a hospital not participating in the registry.

The sharing of data takes place through a secure transfer of data from a hospital’s electronic health records (EHR) system. All information is submitted via files to the registry’s secure site. Using both a SFTP and HTTPS service, AJRR is able to automatically encrypt all the data being transferred over. Berry emphasized that members do not have access to other members’ specific data, only national norms.

Participation in the AJRR also includes assistance with several federal quality initiatives, insurer’s distinction programs, and state collaboratives like Aetna Institutes of Quality, Blue Shield of California, Comprehensive Care for Joint Replacement (CJR), Maintenance of Certification (MOC), Meaningful Use, Physician Quality Reporting System (PQRS), The Alliance Cooperative (Midwest States), and The Bree Collaborative (Washington State) that provide incentives for improvements in quality of patient care.

Another benefit of the registry is that recall of specific implants can be communicated in a timelier manner to hospitals so they can notify their patients. With the right amount of data on these procedures, the registry can also detect problems with implants a lot earlier than public health agencies can.

It is not just hospitals that benefit from the registry though. Individual surgeons can use the registry data to help identify patients at risk for poor clinical outcomes and improve patient-follow-up and intervention, which in turn reduces complications and revision rates.

“It provides a tripwire to identify problems faster and to do the best for patients,” Berry said.

Future of Medicine

As medicine becomes more focused on evidence and patient outcomes, the need for data collection will only continue to grow.

Berry said, “We live in an era of data collection. There are a lot of people collecting data. Some data are accurate, but some may have weaknesses or deficiencies. High-quality risk-adjusted data can help correct and inform other people who are also collecting data.”

Berry said that the registry’s ability to risk adjust for diseases, conditions, and other patient characteristics that vary from hospital to hospital and may affect surgical outcomes, will allow for a "leveling" of the playing field across all patients regardless of comorbidities, or the existence of two conditions or diseases in a patient. This takes into account circumstances that might not be under the surgeon and hospital’s control which may affect surgical results and how hospitals are viewed when handling more complicated cases.

“Hospitals and physicians can use their AJRR data to compare themselves to national benchmarks and to what other data sources are saying about them. They can find out what they do well and what they need to improve on,” he said.

He added that as the AJRR data becomes more robust, they will be able to do more with the data. The AJRR hopes to soon have enough longitudinal data to also conduct survivorship analysis and provide risk adjusted outcome information which will further advance orthopedic care for patients. Other national joint replacement registries like the Swedish Hip Arthroplasty Register have already proven that monitoring survivorship reduces revision rates, which in turn also reduces overall cost. According to the registry, if the U.S. revision rates were reduced by just 2%, over $65 million dollars in Medicare costs could be saved.

A Call for Good Citizenship

Richard L. Illgen, M.D, professor of Orthopedics, co-director of the University of Wisconsin-Madison Health Joint Replacement Program, and chairman of the AJRR Research Committee has been a part of the AJRR efforts for a decade.

“The University of Wisconsin Department of Orthopedics and University of Wisconsin Health have been early members of the AJRR and have been fully supportive of these efforts,” he said in an interview with OTW.

Illgen has served as a local champion for participation in the AJRR and has served at the national level. Currently he is chair of the AJRR Research Committee. He has seen firsthand how important a national registry for total joint replacement is.

He said benefits for the local hospital “include transparent data regarding outcomes for patients that have had joint replacement at multiple different centers with multiple different joint replacement types of implants.”

He added that the national data can also be quite helpful to identify failure of implants and any trends that can be applied to the ongoing care of patients requiring joint replacement surgery.

On why it is important for more hospitals and surgeons to participate in the registry, he said, “The strength of a registry relates directly to the rates of participation. In Australia and the United Kingdom, participation in the registry is mandatory in their national health systems.”

“The ability to collect high quality data over long periods of time at a nationwide level is fundamental to the success of the AJRR. As such, it is vitally important that all members of the orthopedic community collect and report these data for the betterment of our patients.”

Learn more about how you can get involved in the AJRR here.

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