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4 updates to the joint-replacement registry—and why they matter

Specialty-specific clinical data registries can be a useful tool for physicians and group practices to submit data to government or commercial quality-reporting programs. And they can be used to conduct research on best practices and spot trends on what’s working and what isn’t.

The American Academy of Orthopaedic Surgeons’ (AAOS) efforts to do this with its American Joint Replacement Surgery (AJRR) are beginning to blossom. The AJRR now holds data on almost 1.5 million hip- and knee-replacement procedures between 2012 and the first quarter of 2019, covering nearly 9,000 surgeons at more than 1,000 institutions.

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The AJRR is developing into a model that other specialties may want to emulate. Here are four reasons why.

The registry now includes data from the Centers for Medicare & Medicaid Services (CMS). The AJRR began receiving CMS claims data June 2018. The goal is to use that information to assess registry data quality, monitor long-term patient results—including reoperations that occur anywhere in the U.S.— and give insight into patient comorbidities for risk adjustment, according to an AJRR blog post.

Also obtained was data from all Medicare patients whose records were included in AJRR between 2012 and 2018, according to the most recent AJRR annual report. This has helped fill gaps in AJRR data, said AAOS Medical Director William O. Shaffer, MD, adding that there are efforts to get similar data from commercial payers.

The AJRR’s Orthopedic Quality Resource Center has been operating as a qualified clinical data registry (QCDR) since 2014. It is the first QCDR to obtain CMS data. Starting July 1, the AJRR will be the sole pathway to meet the Joint Commission registry participation requirement for hospitals and ambulatory surgery centers seeking advanced total hip and knee replacement certification.

A QCDR is a CMS-approved vendor that is in the business of improving health care quality. QCDRs collect clinical data from clinicians and report this data to CMS on their behalf for purposes of satisfying MIPS.

Other specialty-society QCDRs include the:

  • American College of Radiology’s National Radiology Data Registry.
  • American College of Emergency Physicians’ Emergency Quality Network.
  • American College of Cardiology’s two outpatient registries, the Pinnacle Registry and the Diabetes Collaborative Registry.

The AMA and the PCPI’s National Quality Registry Network are hosting a conference for the QCDR steward community on May 8 at the AMA headquarters in Chicago.

Patient-reported outcome measures are included. The AJRR includes data that covers procedural information, post-operative elements and patient-reported outcome measures (PROMs). There are promising efforts afoot to embed the process of reporting outcome measures into the workflow of patient care and make it easier for surgeons and institutions to participate.

Robust database allows for accurate risk adjustment. The addition of the CMS claims and PROM data build on efforts to add to the AJRR’s numbers by working with state-based registries, most notably the California Joint Replacement Registry.

There’s been an increase in peer-reviewed research based on AJRR data and more robust data capture will allow for risk-adjusted case analysis and pay-for-performance program participation.

The registry now captures data pertaining to surgical approach, procedure duration, length of stay and use of computer navigation and robot-assisted surgery. Goals include more data on tracking surgical complications and risk-adjustment data such as patient comorbidities, body mass index and discharge disposition.

“These new capabilities are critical to the long-term success of the registry to deliver more comprehensive and informative feedback,” the AJRR report stated.

More improvements to come. Recent improvements to the registry included enhanced benchmarking, improved search functions, better data validation, and making data collection less burdensome.

Plans call for dashboard security upgrades, introduction of performance measures and even more benchmarking enhancements.