Online Program

American Joint Replacement Registry (AJRR): Results of a level II data reporting pilot study

Monday, November 2, 2015 : 11:10 a.m. - 11:30 a.m.

September Cahue, MPH, American Joint Replacement Registry, Rosemont, IL
Caryn Etkin, PhD, MPH, American Joint Replacement Registry, Rosemont, IL
AJRR is a multi-stakeholder, not-for-profit clinical data registry with a goal of optimizing patient outcomes through collection of data on all U.S. total joint replacement procedures. In 2014, AJRR implemented a pilot study to evaluate hospitals' and physician practices’ capabilities and barriers to submission of data beyond basic procedural data currently collected.  The new Level II elements will give AJRR the ability to risk adjust the national data set. Volunteer hospitals were solicited from N=123 reporting procedural data.  Hospitals received a study protocol with data specifications covering 41 new data elements (patient co-morbidities, infection and thrombosis prophylaxis, selected lab values, American Society of Anesthesiologists (ASA) scores, and surgical complications).  Hospitals extracted data from their Electronic Health Record (EHR) system and were allotted five months for data collection, allowing time to capture post-operative complications.  All hospitals participated in individual structured-interview sessions to provide feedback regarding acquisition of Level II elements. A sample of N=18 hospitals participated including data on N=7,984 procedures.  All hospitals extracted and reported ICD-9 codes for patient co-morbidities and ASA scores, but widely variable reporting was also noted.  For example: 8 of 18 hospitals submitted serum albumin data, whereas 10 hospitals submitted total lymphocyte values.  Only 7 hospitals reported on antibiotic prophylaxis, though there is reported high documented compliance nationally with this process measure.  Although 13 hospitals reported complications, the total number reported was small.  Technical variability explained the inconsistent reporting.  Full reporting of Level II data, with varied hospital requirements and numerous EHR vendors, will be challenging for the near future.  As registries expand and proliferate, we expect data elements will be required for federal initiatives, which will drive hospitals and EHR vendors to include elements in a consistent manner. In absence of mandated or incentivized reporting, high rates of complete data capture will remain elusive.  

Learning Areas:

Communication and informatics
Public health or related research

Learning Objectives:
Discuss the application of a national total joint replacement registry to enhance patient safety, improve quality of care, and reduce cost of care. Identify the benefits and challenges in electronic data collection and submission utilizing Electronic Health Records (EHR) at a national level. Assess the need for national initiatives to support registries ability to collect data.

Keyword(s): Information Technology, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the senior registry analyst for the American Joint Replacements Registry (AJRR) for the past 2 years focusing on electronic data collection and analysis of a national data set of all total joint replacement procedures performed in the U.S. Among the AJRR's goals is to optimize patient outcomes by analyzing implant performance longitudinally. Prior to this initiative, my area of interest has been examining the biomechanical factors that may influence knee osteoarthritis progression.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.