Imagine how your site can leverage insights to enhance patient care. Explore AJRR case scenarios to discover the transformative impact of data-driven healthcare.
Support Clinical Decision Making
Scenario: Hospital notes above national average readmission rates for mechanical complications in female patients over 60 receiving a total hip replacement
Application: Quality manager uses dashboard data and reports to identify additional commonalities across the readmission group such as surgical approach, component types, and inpatient versus outpatient setting. This data is discussed with surgeons at an ortho department meeting, and it is determined that short stem implants for their hip cases have worse outcomes for females over 60, and additional bone health pre-op testing should be implemented prior to implant decision in this group.
Address Gaps in Patient Care
Scenario: Surgeon filters his PROMs dashboard by race to compare groups meeting the minimum clinically important difference (MCID) at 1-year post-op. There is a significant drop in the achievement rate in their black patient population. Upon drilling down further into the PROMs page, it is revealed that this group has a lower pre-op PROMs completion rate, too.
Application: The surgeon takes this back to the ortho nurse navigator to discuss improving pre-op communication and materials tailored to each patient group, and to reassess how they are currently offering pre-op education – virtual, in-person, or packet for patient review – and determine if this needs to be adjusted/optimized.
Identify Best Practices
Scenario: Orthopaedic surgical department notices a wide variance in outcomes across their inpatient total hip replacement patients with similar demographic and clinical history for Q3 2023. They drill down further into the case details for this time.
Application: Upon analysis, they identify lower complication rates associated with successful physical therapy on the day of surgery (PT_Day_0). The lead PT does a training session for the rest of the nursing and PT team on ambulation and patient motivation techniques, leading to improved outcomes and reduced complication rates in subsequent surgeries.
Inform Care Protocols
Scenario: Length of stay (LOS) longer for a hospital’s total hip patients than national average for similar institutions
Application: Upon reviewing the case details for the cases with LOS greater than national average, it is noted that the op time and need for blood transfusion were higher in these patients. This finding presents the ortho department with the opportunity to review their surgical techniques and perioperative blood management to increase efficiency and reduce postoperative complications delaying discharge.
Monitor Outcomes
Scenario: A quality manager is looking for data on reducing their total knee surgical site infection (SSI) rate
Application: Using the dashboard SSI metric visual, the quality manager drills down to the cases falling into the numerator for 2023. 70% of the cases present with a BMI >28. The quality manager takes this back to the ortho department lead to discuss preop education and nutrition guidance for their obese patient population to optimize preop care and health and improve post-op outcomes.
Utilize Patient-reported Outcomes (PROMs)
Scenario: A small hospital’s average HOOS, JR. scores are significantly lower that the national average at 3-months post-op for the past quarter.
Application: Upon reviewing the PROMs Assessment Summary Report available in RI, it is noted the patients with lower scores are also those presenting with additional comorbidities. After reviewing current pre-op risk management protocols, the Ortho Line Navigator determines there is an opportunity to provide additional patient education with the PROMs results to share the expected progression and outcomes of hip replacement in the context of a patient’s own health.
Maintain Standards of Care
Scenario: An increase in total hip arthroplasty failures is noted in AJRR over time
Application: This trend in the data is identified through a RAI study and provides an avenue to discuss the role of Cemented Stems in preventing these THA failures when presented via poster at the International Society of Arthroplasty Registries (ISAR) Annual Conference and the Western Orthopaedic Conference. Surgeons viewing this poster are motivated to examine their own AJRR dashboards and revision rates for THA and assess their fixation and treatment approaches.
Inform Future Measures
Scenario: Upon analysis of the AJRR data set, a gap in care for a treatment supported by AAOS clinical practice guideline for fracture-related hip arthroplasty
Application: AAOS develops a new Qualified Clinical Data Registry (QCDR) measure to track the rate at which surgeons use cement fixation for hip arthroplasty with a diagnosis of proximal humerus fracture. The data set also guides the need for exclusions from the measure based on patient risk-factors. Our ability to link to the CMS data set also allows for longitudinal outcomes to fully test the measure.
Research Opportunities
Scenario: The 2023 Annual Report Supplement demonstrates the generalizability PROMs data collected in AJRR
Application: Surgeons and Institutions participating in AJRR can confidently use the peer and national comparisons for PROMs data as it applies to the broader, general joint replacement patient population. This also confirms a reliable data set for future research utilizing PROMs data for comparative analysis studies through RAI for individual surgeons utilizing the dashboard for continuous learning and seeking improvement opportunities when assessing and benchmarking their own PROMs scores.
Reimbursement for Quality Care
Scenario: Hospital needs to fulfill reporting requirements for the IQR THK/TKA PRO-PM
Application: Through submission of AJRR procedure and PROMs data, including CMS-labeled risk elements and matching identifiers (Medicare Beneficiary ID), the hospital quality manager tracks their pre- and post-op PROMs completion rates on a case level via the IQR PRO-PM report. Scorecard visuals tracking pre- and 1-year post-op PROMs completion rates also provides the participant with an overall view, providing a quick update on the hospital’s progress towards the 50% threshold set by CMS. After signing a data consent form and reviewing the report for any data errors, AJRR submits the data to CMS on the hospital’s behalf, and the hospital is able to review and confirm success via their Hospital Quality Reporting Portal.
Enhanced Reputation
Scenario: Hospital or ASC looking to obtain or maintain TJC Advanced Certification
Application: Participating site submits hip and knee arthroplasty procedural data, including TJC-specific measure fields, and PROMs data to AJRR. AJRR then applies the TJC measure inclusion and exclusion criteria to the submitted cases and displays the numerator and denominators in TJC-specific dashboard visuals. Site authorized user uses the performance dashboard filters to pull the measure data by month and patient setting (inpatient/outpatient) and then uses the TJC Data Detail Report to drill down into case details for any measure fallouts to identify areas of improvement. Through demonstrating use of this data to TJC during the site visit, the AJRR participant receives the gold seal for Advanced Certification, enhancing their reputation as a quality joint replacement institution and steering patients towards their surgeons.