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AJRR Subscriber Captures the Intersection of Data, Evidence-based Medicine, and Integrated Clinical Pathways

This article was originally published in the July 2018 issue of AAOS Now, the American Academy of Orthopaedic Surgeons' (AAOS) monthly news magazine. It is the second of a three-part series illustrating practical aspects of American Joint Replacement Registry (AJRR) participation through success stories from subscribing institutions. The next installment will feature MountainView Regional Medical Center and appear in the August issue of AAOS Now.

The AJRR is the largest hip and knee arthroplasty registry in the United States, exceeding the 1 million procedures milestone in 2017, and is a part of the Academy’s growing family of orthopaedic registries. TriHealth Good Samaritan Hospital (GSH), located in Cincinnati, OH, has been an AJRR subscriber since January 2015. Other health care institutions can learn from GSH’s registry-supported integrated clinical pathway (ICP) and adverse event (AE) reduction programs focused on blood transfusion, venous thromboembolism (VTE), ineffective pain management, and more.

Since its inception (January 2018), this blog's following has been growing steadily. We would like to take the opportunity to thank our readers for their participation, contributions, and feedback. Currently, 5,000 health care professionals receive the American Joint Replacement Registry (AJRR) Blog by email weekly. Others access it though the AJRR website, via a keyword search on the Internet, or on Twitter. Our audience consists of AJRR participants/subscribers, other AJRR stakeholders, and institutions that have indicated an interest in joining AJRR. 

Most Popular Content 

Blog content is chosen to address diversified, sometimes controversial, clinical and registry issues/opportunities. Some of the most popular topics deal with translating registry findings into clinical practice. The selection criteria for our most popular blogs-to-date (Top 5) are based on number of views, submitted comments, and reader follow-up requests. In case you've missed any of the Top 5 blogs as identified by the actions of your peers, access them below. You can also share past blogs that may interest your colleagues with the social media icons below the title of each blog post.

As the Electronic Health Record (EHR) becomes the primary interface for physicians and other health care workers, the American Joint Replacement Registry (AJRR) must increasingly work through EHRs for greater interoperability to be achieved.

Providers’ EHR Challenges

Today many hospitals, ambulatory surgery centers, and clinicians’ offices use more than one data capture system. In other words, more than one EHR within a single provider system may be utilized to support registries like AJRR. As a result, data capture can be awkward and time consuming for clinicians and their staff. While some of this can be overcome without interoperable systems, for example by uploads from these systems to AJRR of specific standard file formats, AJRR continues to pursue improvements aligned with the overall industry effort.

June is National Safety Month. For the American Joint Replacement Registry (AJRR), part of the American Academy of Orthopaedic Surgeons (AAOS) Registry Program, every month is safety month. Many registries around the world began with a mission of monitoring patient safety factors, including medical devices. Over the years, their missions have expanded to include broader data-driven, quality improvement efforts.

William J. Robb III, MD, AAOS TeamSTEPPS mentor, said, “Without safety, there is no quality or value; safety is the kernel around which all else is built.”

This article was originally published in the June 2018 issue of AAOS Now, the American Academy of Orthopaedic Surgeons' (AAOS) monthly news magazine. It is the first of a three-part series illustrating practical aspects of American Joint Replacement Registry (AJRR) participation through success stories from subscribing institutions. The next installment will feature TriHealth Good Samaritan Hospital and appear in the July issue of AAOS Now.

The AJRR is the largest hip and knee replacement registry in the United States and a leader worldwide.

Providence St. Joseph Health (PSJH) shares highlights of its road to participation in the AJRR including some of the achievements attained along the way. Other health care institutions can learn from PSJH's experience in developing best practices in system-wide data collection (86,990 cases submitted as of January 2018), data-driven quality improvement (patient reported-outcome [PRO] program), and utilization of the data for research purposes (dual mobility cup utilization and indications analysis).

The voice of the patient is evident in the efforts of the American Joint Replacement Registry (AJRR) largely because of contributions from the Public Advisory Board (PAB). The mission of the PAB is to improve the value of AJRR by even more effectively ensuring a public voice in the Registry's hip and knee replacement data collection, reporting, and utilization activities. Each year, PAB members play an important role in compiling a Report to the Public About Hip and Knee Replacements. The Report's registry-driven, evidence-based content is invaluable in answering the most frequently asked questions (FAQs) from patients and their families. Well-informed patients, with current information, will seek better care and gain better outcomes.

This week's blog focuses on the Report to the Public's answers to patients' FAQs. As a complement to the Report, the blog also features Richard Seiden's account of his personal joint replacement experience and the general patient advice he is sharing through an article he recently authored. He has been a PAB member since 2016.

Orthopaedic nurses are important stakeholders in the mission and success of registries. Like other health care practitioners, they improve orthopaedic care through the collection, analysis, and reporting of actionable registry data that contributes to better patient outcomes.

The National Association of Orthopaedic Nurses (NAON) was formed after a meeting convened by Nancy Hesselbach, RN, and Barbara Fiehler, RN, with fellow orthopaedic nurses at the American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting on March 8, 1980 and incorporated April 14, 1980 in Missouri. NAON's mission promotes orthopaedic research, education, and nursing practice. At their 38th Annual Congress on May 19-22, 2018 in Albuquerque, New Mexico, educational offerings about registries will include presentations from both AJRR and the American Orthopaedic Association (AOA). Today's blog provides a preview of presentation content that helps fulfill NAON's mission, along with making a difference to hospital, physician practice, and nursing quality improvement.

Watch and Learn From 12 International Registry Presentations

The American Academy of Orthopaedic Surgeons (AAOS) is committed to encourage and provide lifelong learning opportunities to its members and that is exactly what it did at the International Society of Arthroplasty Registries (ISAR) Symposium at its 2018 Annual Meeting. "What Can a Registry Do for Me?" showcased a dozen real-world data outcome uses from registries around the world and presented data and insights gained through these registry efforts.

ISAR members have a shared purpose of improving outcomes for individuals receiving joint replacement surgery worldwide. The focus of the society is to utilize the strength of cooperation and sharing of information and further enhance the capacity of individual registries to meet their own aims and objectives. 

A recording and slide presentation of "What Can a Registry Do for Me?" is organized under four subject areas:

• Part 1 - Health Care Quality and Payment
• Part 2 - Identify Clinical Best Practices and Improve Patient Care
• Part 3 - How to Use Your Own Data
• Part 4 - Implant Selection and New Technology

Today's blog provides a "front-row seat" for you to listen and view the complete symposium content. Symposium highlights are also below.

This week's blog will guide AJRR participants in updating their 2018 Registry workflows, data submission capabilities, and case analysis efforts. After listening to and incorporating participant feedback, AJRR Data Specifications 07.13.2017 Revision 1 and AJRR Data Dictionary Version 2 were released on April 30, 2018. These Registry upgrades added new data elements and deleted, merged, and renamed data fields to create a more user-friendly and comprehensive Post-Operative Complication (Post-Op Comp) File Layout. AJRR has three layouts that it asks participants to submit: the Procedural Layout, Patient-Reported Outcome Measures (PROMs) Layout, and Post-Op Comp Layout.

The new Post-Op Comp Layout contains important Level II measures that will, for the first time, allow for risk-adjusted case analysis.

In the American Joint Replacement Registry (AJRR) 2017 Annual Report, infection was identified as a leading cause of total knee arthroplasty (TKA) and total hip arthroplasty (THA) revisions from 2012 to 2016. The majority of early (<3 months) linked TKA revisions are for infection. The majority of early (<3 months) linked THA revisions are for dislocation, infection, and periprosthetic fracture. With an increasing number of TKA and THA procedures being performed in the United States, the rate of failure has also increased. In 2017, AJRR compared and analyzed data for infection-related revision surgeries from six arthroplasty registries including AJRR. The authors presented their poster at the International Society of Arthroplasty Registries (ISAR) 6th International Congress (May 2017). The results showed that for both hip and knee arthroplasty, each registry with six-year data showed an increase in infection burden over the period of the survey.