Surgeons Submitting AJRR Data

Slow but steady.

While orthopedic surgeons gradually are filling the American Joint Replacement Registry (AJRR) with procedural data, submissions are more sluggish than administrators prefer. “It has been slow going although we hope to get there,” AJRRboard member William J. Maloney, M.D., noted last week during an industry gathering. “It isn’t still a done deal, but there is a lot of potential.”

Surgeons are downloading statistics on roughly 2,000 joint replacement procedures weekly, Maloney said. Information on more than 65,000 procedures currently are stored in the registry, with 125 hospitals contributing data, and 145 business associate agreements have been signed that represent 238 total hospitals.

Organizers, however, still have a long way to go to achieve their goal of 90 percent participation from the estimated 5,000 U.S. hospitals that host arthroplasty procedures. The foundation is in place, though: orthopedic electronic health record vendor agreements are in place, and Epic (Verona, Wis.) and Cerner (Kansas City, Mo.) have created AJRR-specific Level I reporting modules. Also, finalized AJRR polices and procedures for data reporting have been developed, Maloney said.

The AJRR is designed to improve arthroplasty patient care and keep recall-related costs down by helping to identify specific problems with implants. It gathers basic information (deemed “Level I” data) to monitor artificial joints throughout recipients’ lifetimes. The Level I data include patient, surgeon and hospital identification as well as procedural facts and implant details. In 2012, the registry began collecting Level II, III and IV data to risk-adjust hospital and revision results. Level II data includes patient risk factors and comorbidities (as identified through ICD-9 codes); Physician Quality Reporting System measures; surgical approaches; prophylaxis; and American Society of Anesthesiologists scores.

Level III data encompasses 36-Item Short Form Health Survey; hip disability and osteoarthritis outcome score; knee injury and osteoarthritis outcome score; Modified Western Ontario and McMaster Universities Arthritis Index; Oxford Hip and Knee scores; Knee Society Knee Scoring System; and Harris Hip Score. Level IV data includes radiographic images. In November, the AJRR launched its pilot program for Level II and Level III platforms at 15 participating sites.

The AJRR’s pilot program began in October 2010 with 15 hospitals and concluded in June 2011 with eight institutions and 11 hospitals involved. Software for the program was launched in June 2012, four months after the registry made its official debut.

The registry currently does not have participating sites in Alabama, Oklahoma or Rhode Island.