The more than 770,000 Americans who have hip and knee replacements each year, and the surgeons who perform them, lack important comparative information on the quality of artificial joint devices and data — both positive and negative — on the outcomes of those procedures.
Responding to this information vacuum, the California HealthCare Foundation (CHCF) joined with the Pacific Business Group on Health (PBGH) and California's leading group of orthopaedic surgeons, the California Orthopaedic Association (COA), to establish the California Joint Replacement Registry (CJRR).
Over the past year, the CJRR worked with three hospitals to build the registry software and pilot data collection on total hip and knee replacements, including patient demographics, device information, clinical data on other patient conditions that could affect the results of their surgery, and patients' self-reported outcomes.
A hallmark of the registry is its ability to survey patients before and after their surgeries, providing doctors and hospitals with valuable information about patients' physical progress. The project, which is governed by a board with a majority of surgeons, is now poised to expand to more hospitals.
Registries like the CJRR help physicians, hospitals, and device manufacturers discover and respond quickly to problems that can arise with the devices or the medical techniques used to replace knees and hips, noted Mark D. Smith, MD, MBA, president and CEO of CHCF, which is funding the project. PBGH manages the CJRR's day-to-day operations.
"We lack comprehensive, scientific assessment of these devices, treatment protocols, and surgical techniques," said PBGH CEO David Lansky, PhD. "This paucity of quality information can lead to suboptimal care, poor outcomes, and added costs."
"With an active registry, providers, patients, and those who pay for the replacements will have the information they need to make informed choices and surgeons will be able to track and improve care," said Smith of CHCF. "Our goal is to inform the decisionmaking process for both providers and patients, ultimately helping to improve the quality of care in California."
The project will promote the use of quality information for joint replacements to enable better decisionmaking by patients, physicians, other providers, and purchasers. It will also provide insight into how often surgeries have to be repeated and examine the trends of specific surgical complications.
"Physicians, hospitals, device manufacturers, health plans, and patients are all seeking objective information to help guide their decisionmaking," said Kevin J. Bozic, MD, MBA, chair of the CJRR steering committee and first vice president of the COA. "By creating an infrastructure for data collection, the CJRR will facilitate a better understanding of how patient, surgeon, hospital, and device factors influence joint replacement patient outcomes."
In August, the registry successfully completed a pilot at Cedars-Sinai Medical Center (Los Angeles); Hoag Orthopedic Institute (Newport Beach); and the University of California, San Francisco. In the coming year, the CJRR will be streamlining registry data-collection efforts and adding six new hospitals.
Recent Research Points to Need
Recent CHCF research on the wide variation of regional rates for 13 elective procedures in California also highlights the need for the registry. In Joint Replacement in California: A Close-Up of Geographic Variation, the rates of elective hip and knee replacements varied markedly with residents in several communities undergoing such surgeries at rates significantly higher or lower than the state average.
The variation research poses many questions. The CJRR aims to provide some answers. Because the registry tracks patient condition before and after joint replacement, the data gathered from the project could ultimately help explain when (and for which patients) the procedure helps to relieve symptoms and where it may not, as well as inform device selection and surgical techniques.