Published 2/1/2013

AJRR: Making Enrollment Easier

How your hospital can become part of the movement

Caryn D. Etkin, PhD, MPH, and Susan E. Hobson, MPH

With more than 100 participating hospitals, the American Joint Replacement Registry (AJRR) has been able to streamline the enrollment process and make it easier for orthopaedic surgeons and their affiliated hospitals to participate in this important quality initiative. This article outlines the enrollment steps; readers should feel free to share it with key hospital decision makers.

How to sign up
Information is critical to making any decision, and the AJRR website (
www.ajrr.net) has plenty of materials available at no cost. Plus, AJRR staff are ready to answer any specific questions or provide additional materials.

A conference call with AJRR staff is recommended after the materials have been reviewed by the hospital team. Many hospitals have individualized questions or concerns that can be raised and addressed early in the process to facilitate easier and quicker participation.

Including a representative from the hospital legal department on the call can help speed the enrollment process. Many hospital attorneys have a long queue of priorities, so it’s important to get AJRR contract documents in that queue early.

Another important department to involve is the hospital’s information technology (IT) division. IT staff need to know about the AJRR’s technical requirements so they can gather the necessary information for AJRR data submission. Level I data that can be extracted and aggregated from the facility’s healthcare IT system(s) can be uploaded to the AJRR Secure File Transfer Protocol site. Or, data may be submitted via manual data entry, directly into the registry, using a secure account for hospital staff. All data submission methods are compliant with Health Insurance Portability and Accountability Act (HIPAA) regulations.

The hospital’s Institutional Review Board (IRB) may also need to be involved. Although local IRB waivers of HIPAA privacy requirements and Common Rule consent requirements are not needed for participation in a joint registry, individual hospital policies may require that they be obtained.

Both the U.S. Department of Health and Human Services (HHS) Office for Civil Rights and the HHS Office of Human Research Protections have endorsed the use of central IRB waivers of consent for registries. The AJRR has received waivers of HIPAA authorization and informed consent requirements from the Western IRB.

Data reports
The AJRR’s publicly available annual reports will include the following data (all de-identified):

  • Procedure frequency—nationally and by state or region
  • Devices used with device-specific survivorship
  • Volume effects by surgeon and hospital type (eg, academic or community)
  • Early warning surveillance of new technology

Participants will have access to the AJRR electronic custom reporting system. Custom reports can provide more specific or individualized data for surgeons, hospitals, manufacturers, payers, and government agencies. All data shared with manufacturers, payers, and the government will be de-identified. Only participating hospitals and individual surgeons will have the opportunity to view identifiable data.

Learn more in March
The AJRR will present an information session during the AAOS 2013 Annual Meeting in Chicago, at 9 a.m. on Wednesday, March 20, in McCormick Place, room S405. Moderated by William J. Maloney, MD, chair of the AJRR Board of Directors, and David G. Lewallen, MD, immediate past chair, the session will be an opportunity for orthopaedic surgeons, hospital executives, nurses, and others to learn about how the AJRR operates and what it can provide.

Caryn D. Etkin, PhD, MPH is research director and Susan E. Hobson, MPH is research associate for the AJRR. If you are interested in learning more about the AJRR, please contact them at 847-292-0530, via email at info@ajrr.net, or online at www.ajrr.net

About the AJRR
The AJRR is a nonprofit 501(c)(3) organization for data collection and research on total hip and knee replacement. The AJRR is a collaborative effort supported by the AAOS, the American Association of Hip and Knee Surgeons, the Hip Society, the Knee Society, hospitals, health insurers, and medical device manufacturers. For more information, visit

AJRR data collection
Of the four data levels collected by other arthroplasty registries, the AJRR is currently accepting Level I data, which are mandatory and include the following:

  • information on patients (eg, name, gender, date of birth, and diagnosis)
  • surgeon name and National Provider Identifier (NPI)
  • hospital name and NPI
  • procedural information, including the implanted component catalog and lot numbers

Level II data, which allow the AJRR to risk adjust hospital and physician revision results, include the following elements:

  • expanded procedural data (eg, approach, fixation, technique, operating room time);
  • pre- and postoperative assessments (eg, deep venous thrombosis and infection prophylaxis, length of stay, and Physician Quality and Reporting System [PQRS] information);
  • American Society of Anesthesiologists (ASA) scores;
  • patient comorbidities (eg, obesity, coronary artery disease, diabetes);
  • complications (eg, neurovascular injury, pulmonary embolism, dislocation, myocardial infarction, infection, fracture, renal failure, death).

Level III data reflect Patient Reported Outcomes, and the instruments and scoring are provided to hospitals as a service; participation in this level of data collection is not mandatory. Level III instruments available through the AJRR include the following:

  • 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 McMasters University Osteoarthritis Index (WOMAC)
  • Oxford Hip and Knee Scores
  • Knee Society Knee Scoring System©
  • Harris Hip Score

Due to licensing constraints, the AJRR is unable to offer the EQ-5D or the SF-12, but its system is able to accept those scores, if the hospital has a license.

Level IV data include radiographic images, which the AJRR can readily accept at this time.

AJRR is currently developing the registry forms and data fields necessary to acquire Level II, III, and IV data. In the second quarter of 2013, AJRR will launch these capabilities and detailed hospital quality metric reporting. AJRR is also working on Maintenance of Certification and Surgical Care Improvement Project measure definitions.