AAOS Registry Program Blog

Study Scours AJRR Data for Traits of Submitters, Patient Response Trends

Mar 27, 2019 12:00:00 PM

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This blog is the second in a three-part series reporting on orthopaedic studies presented at the 2019 American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting and utilizing American Joint Replacement Registry (AJRR) registry data. All presentations are reported by Terry Stanton, senior science writer for AAOS Now.

 

Paper 877, “An Early Look at Patient-Reported Outcome (PRO) Data” was presented by Kevin J. Bozic, MD, MBA, chair of the AJRR, on Thursday, March 14, 2019 at the AAOS Annual Meeting in Las Vegas, Nevada. The study offers an “early look” at patient-reported outcome (PRO) data from the AJRR, a part of the AAOS Registry Program. Dr. Bozic explained that the study covered differences between patient-reported outcome measures (PROMs) from submitters and nonsubmitters and the response rates tallied so far for PROMs.

AJRR developed a PROM platform that was made available to Registry participants in 2016. Suggested PROMs for total joint replacement patients included the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR.), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR.), Patient-reported Outcomes Measurement Information System (PROMIS) Global Health, and Veterans RAND 12-item health survey (VR-12). The California Joint Replacement Registry (CJRR), which was integrated into AJRR in 2017, required submission of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); VR-12; and University of California, Los Angeles Activity Score. 

By the end of October 2018, 142 of 753 (18.9 percent) AJRR institutions submitted PROM data.  Of those submissions, 134 sites (94.4 percent) submitted the AJRR-recommended PROMs (HOOS, JR.; KOOS, JR.; PROMIS-Global, and VR-12). Hospital size and teaching type of submitting institutions were defined per the AHA Annual Survey Database Fiscal Year 2015. There was no significant difference between PROM submitters and nonsubmitters in terms of teaching versus non-teaching institution. However, for bed count, PROM submitters were significantly different: 54.9 percent of submitters were medium size (versus 45.0 percent of nonsubmitters) and 31.3 percent of submitters were large size (versus 19.3 of nonsubmitters) (P < 0.001). Of all AJRR PROM submitters, 30 institutions (21.1 percent) were from CJRR. As such, significantly more hospitals in the western region submitted PROMs compared to other U.S. regions (P < 0.001). 

In terms of patient response rates, there was no difference in mean age or sex between patients who completed both a preoperative and one-year postoperative PROM (mean age, 68 ± 9.72 years; 57.3 percent female) and patients who did not complete both PROMs (mean age, 67 ± 11.2 years; 57.8 percent female). Although there was no difference in mean age, when age was stratified by decade of life, completion of PROMs was comparable in patients aged 70–79 years (33.3 percent) and 60–69 years (37.4 percent).

Sixty-three of the 142 AJRR institutions (44.3 percent) submitting PROMs had at least one linked (baseline and one-year postoperative) assessment. The overall response rates for patients with a linked PROM were 15.2 percent for HOOS, JR.; 18.1 percent for KOOS, JR.; 14.2 percent for PROMIS-Global; and 33.8 percent for VR-12.

For PROM submitters from CJRR, the average response rate for the WOMAC was 15.1 percent (range, 5.2–44.7 percent). Of the linked PROMs, 94.2 percent and 91.4 percent of patients reported clinically meaningful improvement in their scores from baseline to one-year postoperatively in the HOOS, JR. and KOOS, JR. scores, respectively. For quality-of-life measures, meaningful improvement was 43.1 percent for PROMIS Global Mental Health, 75.8 percent for PROMIS Global Physical Health, 39.0 percent for VR-12 Mental Component, and 77.0 percent for VR-12 Physical Component scores.

“PROM completion rates of 15 percent to 33 percent (depending on PROM) suggest that completion rates remain problematic for AJRR institutions, consistent with other studies,” the study authors wrote. “The true challenge of implementing PROMs in a registry while gaining and reporting meaningful results relates to data capture and response rates. Response rates for PROMs across orthopaedics can be a challenge. So, while a provider may intend to achieve high response rates, collection of PROM surveys requires significant manpower dedicated to ensuring high completion rates, and may not yield a robust volume of PROM data.”

The authors concluded: “As more providers begin to incorporate the use of PROMs into their care delivery model, further study is necessary to identify barriers and facilitators to use of registries for PROM measurement. Additional studies may further investigate mode of collection based on patient and institution characteristics, points of contact for collection, and provider buy-in and utilization of PROMs in patient interactions as factors related to data capture and response rates. Registries such as the AJRR reflect the current state of adoption of using PROMs in clinical decision-making, performance improvement, and implementation of value-based payment and delivery models across institutions.”

 

If you have any additional questions about the study, feel free to contact us at RegistryInfo@aaos.org



Dr. Bozic’s coauthors of “An Early Look at Patient-Reported Outcome Data from the AJRR” are Caryn D. Etkin, PhD, MPH; Peter B. Shores, MPH; and September R. Cahue, MPH.

 

For information about the AAOS RegistryInsights platform, speak with a Registry Engagement Associate at (847) 292-0530 or Request A Demo today!

 

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Topics: Registry Findings

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This blog was created by the American Joint Replacement Registry (AJRR), part of the American Academy of Orthopaedic Surgeons (AAOS) Registry Program. The blog is part of our commitment to improve orthopaedic care through the collection, analysis, and reporting of actionable hip and knee arthroplasty data. Our purpose is to communicate with others in the orthopaedic field who share the same commitment. Watch for weekly news alerts, quick tips, actionable checklists, best practices, and research findings posted to this blog. It will be information you can use each week!

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Data Snapshot

Did you know? Data presented in the AJRR 2018 Annual Report reflect 1,186,955 procedures, which includes both primaries and revisions, performed between 2012 and 2017. Patients had a mean age of 66.8, including 41.1% males and 58.9% females. Females make up 61% of the primary total knee arthroplasty population and 55.5% of the primary total hip arthroplasty population. 

Read more in the AJRR 2018 Annual Report.

Figure 9 from the AJRR 2018 Annual Report 

 

This Week's Blog

  • Wednesday, March 27, 2019 - Study Scours AJRR Data for Traits of Submitters, Patient Response Trends

 

This Week’s References

The American Academy of Orthopaedic Surgeons (AAOS) Registry Program

The mission of the AAOS Registry Program is to improve orthopaedic care through the collection, analysis, and reporting of actionable data. The Program's vision goes beyond hips and knees to include additional anatomic registries like the Shoulder & Elbow Registry (SER). Beginning with the American Joint Replacement Registry (AJRR), the AAOS Registry Program is managed by AAOS as a multi-stakeholder participation model. Stakeholders include representatives from the orthopaedic surgeon community, device manufacturers, hospitals, private payers, and the public.

 

 

 

AAOS RegistryInsights™

As a health care provider of orthopaedic services, you can access information about joining the AAOS Registry Program and RegistryInsights by visiting www.aaos.org/ajrr or speaking with a Registry Engagement Associate at (847) 292-0530.  Request an AJRR Demo

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AAOS Registry Program Blog posts are researched and created by Registry Program staff writers: Karen Metropulos, Erik Michalesko, and Lori Boukas. If you would like to contact the writing staff, email us at RegistryInfo@aaos.org

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