Published 11/1/2014
Caryn D. Etkin, PhD, MPH; Lori Boukas

AJRR Gains Momentum

National registry expands and provides options for CMS data submission

The American Joint Replacement Registry (AJRR) continues to build a robust national database of primary and revision hip and knee replacement surgeries. As of October 2014, AJRR has enrolled close to 400 hospitals and includes more than 80,000 procedures.

The number of hospitals joining and the AJRR’s continued commitment to build a national registry make this an exciting time in the organization’s history. The AJRR plans to include 90 percent of the total hip and knee procedures performed in the United States. New features of the registry are now taking shape and will soon be available.

Expanded data and capabilities
In November 2013, AJRR launched a pilot study on collecting Level II and III data sets. Level I data sets included basic patient, provider, and procedure information. Level II data attempt to risk stratify patients based on revision status or comorbidities. Level III data will incorporate Patient Reported Outcome Measures (PROMs). (For more details on each of these levels, refer to the online version of this article, available at www.aaosnow.org) With these data, AJRR will be able to provide additional reports and dashboards, risk-adjusted data, and PROMs for those hospitals wishing to use the AJRR web-based platform.

The pilot study assessed the availability of Level II elements in local electronic health record systems and tested Level III workflow models for completing PROMs with patients. Between November 2013 and August 2014, 18 participating hospitals provided AJRR with meaningful information for final development and specification of these levels. Staff have been processing the information and will launch these platforms before the end of the year.

The AJRR Demand Reporting and Electronic Dashboard Service is another new feature that will soon be available for participating hospitals. Users will have access to the registry’s dataset and will have the opportunity to compare their de-identified outcomes to those of similar hospitals (size, teaching status, and other characteristics of interest). These on-demand internal reports will enable hospital staff and surgeons to access national benchmarks for Level I data.

AJRR holds monthly webinars for those interested in learning more about the reporting and dashboard capabilities. For more information, visit AJRR’s website (www.ajrr.net).

Qualified Clinical Data Registry
In May 2014, the Centers for Medicare & Medicaid Services (CMS) designated AJRR as an approved Qualified Clinical Data Registry (QCDR). As a QCDR, AJRR will be able to accept and report on Physician Quality Reporting System (PQRS) measures for Eligible Professionals (EPs). Additionally, patients will be encouraged to provide feedback on the success, side effects, and other outcomes pertaining to their specific treatment and device.

To develop the platform, AJRR is collaborating with CECity, a quality reporting and performance improvement platform provider, certified by CMS as a PQRS vendor. EPs who satisfactorily participate in PQRS through a QCDR may earn the 2014 incentive payment (0.5 percent) and avoid the 2016 payment adjustment (–2.0 percent). Appropriate participation in PQRS may also be used to determine application of an upward, downward, or neutral adjustment for the Value-based Payment Modifier.

To earn the 2014 PQRS Incentive Payment, EPs must report at least nine individual measures, with at least one outcome measure, covering at least three National Quality Strategy domains for 50 percent or more of the applicable patients over 12 months. AJRR is in the process of working with the American Association of Hip and Knee Surgeons (AAHKS) to develop the necessary measures for hip procedures, which will be released as they are ready. The AJRR will be able to accept data pertaining to total knee arthroplasty patients when the web-based platform is launched at the end of 2014.

Learn more in March
AJRR will host an “American Joint Replacement Registry (AJRR) Update on Progress, Collaborative Efforts, and Future Directions” during the AAOS 2015 Annual Meeting in Las Vegas at 10:30 a.m. on Wednesday, March 25. Moderated by Daniel J. Berry, MD, AAOS past president and incoming AJRR chair, the session will be an opportunity for orthopaedic surgeons, hospital executives, nurses, and others to learn about how orthopaedic registries operate and what they can provide.

Caryn D. Etkin, PhD, MPH, is director of analytics and Lori Boukas is director of marketing and communications for the AJRR. To learn more about the AJRR, call 847-292-0530, email info@ajrr.net, or visit www.ajrr.net

About the AJRR
The AJRR is a not-for-profit 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 allow the AJRR to risk adjust hospital and physician revision results and include the following elements:

  • expanded procedural data (eg, approach, fixation, technique, operating room time)
  • pre- and postoperative assessments such as deep venous thrombosis and infection, prophylaxis, and length of stay
  • American Society of Anesthesiologists 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 Outcome Measures (PROMs). PROMs instruments and scoring are provided to hospitals as a service; participation in this level of data collection is optional. 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, AJRR cannot offer the EQ-5D or the SF-12, but is able to accept those scores, if hospitals have a license. Plans are underway for AJRR to add PROMIS-10 and VR-12 instruments.

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

AJRR has developed the registry forms and data fields necessary to acquire Level II, III, and IV data. A pilot study testing these capabilities and detailed hospital quality metric reporting concluded in August 2014.

Additional Information:
QCDR program