AJRR Expands Its Reach

Growing registry now has data on more than 35,000 TJA procedures

Jennie McKee

The American Joint Replacement Registry (AJRR) has made impressive strides since completing its pilot data collection program in 2011. To date, the registry has recruited 140 hospitals across the country to participate in the registry and has obtained data on more than 35,000 primary and revision total joint arthroplasty (TJA) procedures. In 2013 alone, 16 new hospitals have joined the registry and plan to submit data.

Yesterday, during an informational session moderated by William J. Maloney, MD, chair, AJRR board of directors, and David G. Lewallen, MD, AJRR medical director, AJRR representatives discussed the organization’s progress toward becoming the first comprehensive national hip and knee orthopaedic implant registry in the United States.

David G. Lewallen, MD

Representatives also discussed the registry’s plans for the future, such as increasing collaborations with other groups and expanding the registry’s data collection capabilities to enable it to capture a wider range of information.

Closer to goal
The AJRR is continuing to make progress toward its aim of attaining data from 90 percent of the approximately 4,000 U.S. hospitals in which hip and knee TJA procedures are performed.

“The AJRR is now receiving data from numerous community hospitals, as well as large hospital networks, high-volume medical centers, and members of institutional collaboratives, such as the High Value Healthcare Collaborative,” said AJRR Director of Research Caryn D. Etkin, PhD, MPH.

During the informational session, Dr. Lewallen reviewed the factors—including staffing, data security, funding, and governance—necessary for the joint registry to continue its successful hospital recruitment and data collection efforts. The AJRR recently expanded its staff, adding Jeffrey P. Knezovich, CAE, as executive director, and Pamella Leiter, MSA, OTR/L, as director, policy and strategic alliances. More staff members will be hired as necessary to help the AJRR achieve its goals.

Dr. Lewallen emphasized the importance of protecting the security of confidential data and maintaining the registry’s multi-stakeholder governance. He pointed to the need for a sustainable, stable funding model and for ways to support and encourage hospital participation in the registry.

“The AJRR has secured funding commitments through the end of 2013,” said Dr. Lewallen, adding, “AJRR board members participate in numerous activities to encourage incentives for registry participation with various entities, including government agencies, payers, and The Joint Commission.”

Critical collaborations

The registry’s ongoing efforts to collaborate with other U.S. joint registries and international organizations are helping it sustain and grow its efforts. The AJRR continues to discuss collaboration with registries such as the California Joint Replacement Registry and the Michigan Arthroplasty Registry Collaborative Quality Initiative.

“The AJRR and collaborating registries must work out a mechanism for one-time reporting of data to both registry partners,” said Dr. Lewallen, stressing the importance of two-way data sharing to enable local registries to capture revision procedures performed at other institutions. He underscored the need for cooperative efforts to solicit financial support and establish equitable revenue sharing.

“The AJRR may be able to function as the organizational, legal, and financial umbrella organization for other nonprofit registries nationwide,” he said.

Data collection, dissemination

The registry used feedback from its pilot program to refine its data collection and submission processes. Trial participants placed great emphasis on factors such as comprehensive support for all components, flexible data submission methods, data security, and a simple user interface.

“We are prepared to fully explain our approach to meeting all privacy, security, and compliance requirements under both the Health Insurance Portability and Affordability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act for administrative, technical, and physical safeguards,” said Randolph R. Meinzer, AJRR director of information technology.

Currently, the registry captures Level I data, which includes patient, surgeon, and hospital identifiers, along with procedural and implant information. This year, the registry plans to begin collecting Level II data to enable the AJRR to risk-adjust hospital and physician revision results. Level II data will include the following:

• Patient risk factors and comorbidities (as identified through ICD-9 codes)
• Physician Quality Reporting System (PQRS) measures
• Surgical approaches
• Prophylaxis
• American Society of Anesthesiologists (ASA) scores
• The registry also plans to capture the following Level III data:
• 36-Item Short Form Health Survey (SF-36)
• Hip disability and Osteoarthritis Outcome Score (HOOS)
• Knee injury and Osteoarthritis Outcome Score (KOOS)
• Modified Western Ontario and McMaster Universities Arthritis Index (WOMAC)
• Oxford Hip and Knee Scores
• Knee Society Knee Scoring System©
• Harris Hip Score

Finally, Level IV data include radiographic images, which the AJRR can currently accept.

According to Dr. Etkin, the registry is working to develop registry forms and data fields to enable the AJRR to accept these higher levels of data. These capabilities will be pilot tested and subsequently launched in 2013, along with detailed hospital quality metric reporting.

In addition, Ms. Leiter noted that the registry is also examining Maintenance of Certification and PQRS measure definitions.

Publicly available annual reports issued by the AJRR will contain de-identified data on procedure frequency (nationally and by state or region), devices used (including device-specific survivorship), and volume effects by surgeon and hospital type. The reports will also include information regarding early warning surveillance of new technology. In addition, hospitals that participate will be able to receive hospital-specific data available by subscription.

“Participating hospitals receive one license to query the database for a standard set of reports,” said Dr. Etkin. “Other reporting options will be available upon request, for additional fees.”

She added that “custom reports for surgeons, hospitals, manufacturers, payers, and government agencies will also be available.”

A bright future
The AJRR governance structure is evolving; in the coming months, the AJRR plans to initiate a new process in selecting individuals to serve on the Board of Directors, according to Mr. Knezovich. The AJRR will continue to be supported and governed by its various stakeholders and to benefit from public oversight via its Public Advisory Board.

The registry’s financial model calls for a nationwide expansion and ongoing, self-supporting maintenance, drawing on funding from sources such as industry, subscription fees, and grants.

Dr. Etkin exhorted orthopaedic surgeons to continue to help support the AJRR through orthopaedic organizations such as the AAOS, The Hip Society, and The Knee Society. They can also give to the AJRR through the Orthopaedic Research and Education Foundation’s Annual Campaign.

“Encourage your local hospital to participate and report,” she urged. “Consider volunteering as a local surgeon champion and serving as a hospital contact for the AJRR.”

For more information on the AJRR, visit the AJRR booth, located in Academy Hall B, through Saturday.

Learn more
Contact the AJRR at info@ajrr.net or 847-292-0530. To visit the registry online, go to www.ajrr.net

2013 Annual Meeting News
Tuesday through Friday, February 19 – 23, 2013.
http://www.aaos.org/news/acadnews/2013/AAOS8_3_21.asp

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