Joint Replacement Registries in the United States: A New Paradigm

Ayers, David C.; Franklin, Patricia D.

doi:10.2106/jbjs.n.00641

Cited by 40 publications

(32 citation statements)

References 7 publications

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“…By investigating transfusion data from the database and implementing a simple yet effective QI, we were able to reduce transfusion administration over a relatively short period of time. In North America, national and local registries are broadening their focus to include perioperative complications and patient-reported outcomes after surgery [2]. A multicenter TJA registry can provide quality control, timely followup, education to residents and fellows, and a wealth of information to study for research [1].…”

Section: Discussionmentioning

confidence: 99%

Can an Arthroplasty Registry Help Decrease Transfusions in Primary Total Joint Replacement? A Quality Initiative

Markel

Allen

Zappa

2016

Clinical Orthopaedics &Amp; Related Research

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Background Standardized care plans are effective at controlling cost and quality. Registries provide insights into quality and outcomes for use of implants, but most registries do not combine implant and care quality data. In 2012, several Michigan area hospitals and a major insurance provider formed a voluntary statewide total joint database/registry, the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), to collect procedural, hospital, discharge, and readmission data. Noting substantial variation in transfusion practices after total joint arthroplasty (TJA) in our institutions, we used these prospectively collected data to examine whether awareness and education of the American Association of Blood Banks' (AABB) transfusion guidelines would result in decreased transfusions. Questions/purposes (1) Can an established arthroplasty registry help implement a quality initiative (QI) designed to decrease the proportion of transfused postoperative patients undergoing TJA? (2) Do data-driven transfusion protocols decrease length of stay without increasing ischemic complications (myocardial infarctions and cerebrovascular accidents)? (3) Are decreased transfusion proportions associated with decreased readmissions, nonischemic morbidity (including deep vein thrombosis and deep prosthetic infection), and mortality in postoperative patients who had undergone TJA? Methods After reviewing data from the recently established MARCQI registry, the orthopaedic department noticed many discrepancies and practice variances regarding blood transfusions among their providers. In October 2013, a QI was implemented to raise awareness of the discrepancies and education about the AABB guidelines was presented at the monthly orthopaedic service line meeting. A total of 1872 TJA cases were reviewed; 50 were excluded for incomplete data and two for intraoperative transfusions for the period before education (May 2012 to June 2013, n = 1240) and after education (November 2013 to April 2014, n = 580). Data collected included gender, age, length of stay, body mass index, preoperative hemoglobin level, lowest postoperative hemoglobin level during admission, transfusion status, number of units transfused, ischemic and nonischemic morbidity, hospital One or more of the authors (DCM), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 100,001 to USD 1,000,000 from Stryker (Kalamazoo, MI, USA), Arboretum Ventures (Ann Arbor, MI, USA), Novi Bone and Joint (Novi, MI, USA), and CORE (Southfield, MI, USA). One or more of the authors (DCM) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: Stryker and the Orthopaedic Research and Education Foundation (Rosemont, IL, USA) in the amount of USD 100,001 to USD 1,000,000. All ICMJE Conflict of Interest Forms for authors a...

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Section: Discussionmentioning

confidence: 99%

Can an Arthroplasty Registry Help Decrease Transfusions in Primary Total Joint Replacement? A Quality Initiative

Markel

Allen

Zappa

2016

Clinical Orthopaedics &Amp; Related Research

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“…The development and validation process was performed using full HOOS surveys rather than administering the HOOS, JR to new patients. External validation was performed using full HOOS surveys from 910 patients, who had unilateral THAs, from the nationally representative Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) registry who completed preoperative and 2-year postoperative HOOS surveys [1,13].…”

Section: Subjectsmentioning

confidence: 99%

“…It permits each item to have its own unique number of categories and modeled distance between adjacent categories. Overall fit of the data to the Rasch model was evaluated in three ways: (1) information-weighted and outlier-sensitive mean-square statistics for each item were calculated to test whether there were items that did not fit with the model expectancies. Mean squares greater than 0.8 and less than 1.2 were considered acceptable fit.…”

Section: Item Reduction Processmentioning

confidence: 99%

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Validation of the HOOS, JR: A Short-form Hip Replacement Survey

Lyman

Lee

Franklin

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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141

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Background Patient-reported outcome measures (PROMs) are increasingly in demand for outcomes evaluation by hospitals, administrators, and policymakers. However, assessing total hip arthroplasty (THA) through such instruments is challenging because most existing measures of hip health are lengthy and/or proprietary. Questions/purposes The objective of this study was to derive a patient-relevant short-form survey based on the Hip disability and Osteoarthritis Outcome Score (HOOS), focusing specifically on outcomes after THA. Methods We retrospectively evaluated patients with hip osteoarthritis who underwent primary unilateral THA and who had completed preoperative and 2-year postoperative PROMs using our hospital's hip replacement registry. The 2-year followup in this population was 81% (4308 of 5351 patients). Of these, 2371 completed every item on the HOOS before surgery and at 2 years, making them eligible for the formal item reduction analysis. Through semistructured interviews with 30 patients, we identified items in the HOOS deemed qualitatively most important to patients with hip osteoarthritis. The original HOOS has 40 items, the four quality-of-life items were excluded a priori, five were excluded for being redundant, and one was excluded based on patient-relevance surveys. The remaining 30 items were evaluated using Rasch modeling to yield a final six-item One or more of the authors (SL, PDF) has received rsearch support funding from the Agency for Healthcare Research and Quality (Rockville, MD). One of the authors certifies that he (DJM), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000-USD 100,000, from Mako (Fort Lauderdale, FL, USA), an amount of USD 10,000-USD 100,000, from Orthalign (Aliso Viejo, CA, USA), and an amount of USD 10,000-USD 100,000, from Smith & Nephew (London, UK). One of the authors certifies that he (DEP), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Stryker-Mako (Fort Lauderdale, FL, USA). The institution of one or more of the authors (SL, YYL) has received, during the study period, funding from The Starr Foundation (New York, NY, USA). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at the Hospital for Special Surgery, New York, NY, USA. Electronic supplementary material

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“…Surveys are administered via Web interface in physician offices or in a patient's home, by paper distributed at physician's offices, and/or via mail, depending on the surgeon and participating hospital. Many participating surgeons and hospitals employ multiple modalities, including calling patients and sending post card reminders to prompt survey response [5].…”

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confidence: 99%