AAOS Registry Program Blog

August is National Ambulatory Surgery Center (ASC) Month and the American Joint Replacement Registry (AJRR) has invited Alex Taira, Policy Analyst, Ambulatory Surgery Center Association (ASCA), to contribute a guest blog on the evolution and diversity of today’s orthopaedic surgery sites. It has always been the American Academy of Orthopaedic Surgeons’ (AAOS) belief that choosing the appropriate orthopaedic surgery setting is a decision that the patient and the surgeon make together based on a series of factors that lead to the best patient experience and outcome. Today’s patient options include hospitals, hospital-sponsored ASCs, and independent ASCs.

Over 1,000 U.S. hospitals and 68 ASCs participate in AJRR. Based on the number of procedures submitted monthly, AJRR is the largest orthopaedic registry in the world. The AJRR database holds 1.3 million hip and knee arthroplasty procedures from over 8,000 surgeons practicing in one or more types of clinical settings. As more total joint arthroplasties (TJAs) are performed in ASCs, reducing variation and demonstrating quality of care delivered can be accomplished through Registry participation.

The American Academy of Orthopaedic Surgeons (AAOS) and the Virginia Joint Registry (VJR) have entered into a collaborative relationship enabling VJR participants to continue their registry quality initiatives through the American Joint Replacement Registry (AJRR). Virginia Joint Registry board member William Jiranek, MD, said, “The VJR believes that the expanded scope and resources of AJRR will lead to conclusions that will benefit patients beyond the analysis and findings of a single state registry. For example, it will add new capabilities such as national benchmarking.”

This article was originally published in the August 2018 issue of AAOS Now, the American Academy of Orthopaedic Surgeons' (AAOS) monthly news magazine. The article concludes a three-part series illustrating practical aspects of AJRR participation through shared success stories from subscribing institutions. All three installments can be found at www.aaosnow.org.

MountainView Regional Medical Center (MVRM), located in Las Cruces, NM, has been an American Joint Replacement Registry (AJRR) subscriber since November 2014. Their AJRR participation helped MountainView’s Total Hip and Knee Replacement Center utilize Registry benefits to achieve and maintain the Joint Commission’s Gold Seal for core certification. Other health care institutions can learn from the Center’s checklist for choosing a registry capable of supporting a Joint Commission Certified Program.

Measurement of volume metrics are important to the American Joint Replacement Registry (AJRR) because they provide indicators and insights into our data and in what areas we need to focus and improve. With over 1,000 contracted hospitals/surgery centers providing data on more than 8,000 surgeons, annually we collect more arthroplasty procedures than any other registry in the world. Over 1.3 million hip and knee arthroplasty procedures are currently housed in the AJRR database.

AJRR began the Registry because no national comparator for arthroplasty existed. Each year, AJRR makes significant and actionable progress toward becoming that premier resource. Furthermore, we take measures toward demonstrating that our data is both relevant and nationally representative through multiple statistical analysis efforts. Two of those efforts are highlighted below (one is ongoing):

The number of hip and knee replacement procedures by state in the American Joint Replacement Registry.

David G. Lewallen, MD, Medical Director, American Joint Replacement Registry (AJRR), was a featured speaker at the University of Michigan's (UM) "Larry S. Matthews, MD, Adult Lower Extremity Joint Reconstruction Lectureship" on May 18, 2018. He shared portions of AJRR’s development roadmap with his audience, including collaborative possibilities between AJRR and state-based registries.

“As a national registry, AJRR already has a strong presence among its international counterparts. At home, it has successfully collaborated with several state registries under different models. Now, as a part of the American Academy of Orthopaedic Surgeons (AAOS) Registry Program, with access to additional resources, AJRR’s ability to reach out to the states has increased. We are open to exploring opportunities with state registries that share the AJRR mission to improve orthopaedic care through the collection, analysis, and reporting of actionable data,” Dr. Lewallen stated.

This week’s blog shares two examples of AJRR and state registry cooperation. We conclude with a more comprehensive summary of other current AJRR opportunities mentioned in Dr. Lewallen’s UM presentation.

Many of our readers and American Joint Replacement Registry (AJRR) participants have asked for more information about the American Academy of Orthopaedic Surgeons (AAOS) Registry Program to better understand future options available to their organizations. Today’s blog shares information from a June 20, 2018 webinar entitled, “AAOS Registry Program: Opportunities for Engagement and Insights.” Presenters Nathan Glusenkamp, MA, AAOS director of registries, and Kristina M. Finney, MPH, senior manager of AAOS Registry Program and Deliverables, shared a strategic overview of the new program, its mission/vision, the AJRR model, new anatomic program areas, and the value of registry data. Highlights from the webinar are below.

AJRR Subscriber Captures the Intersection of Data, Evidence-based Medicine, and Integrated Clinical Pathways

This article was originally published in the July 2018 issue of AAOS Now, the American Academy of Orthopaedic Surgeons' (AAOS) monthly news magazine. It is the second of a three-part series illustrating practical aspects of American Joint Replacement Registry (AJRR) participation through success stories from subscribing institutions. The next installment will feature MountainView Regional Medical Center and appear in the August issue of AAOS Now.

The AJRR is the largest hip and knee arthroplasty registry in the United States, exceeding the 1 million procedures milestone in 2017, and is a part of the Academy’s growing family of orthopaedic registries. TriHealth Good Samaritan Hospital (GSH), located in Cincinnati, OH, has been an AJRR subscriber since January 2015. Other health care institutions can learn from GSH’s registry-supported integrated clinical pathway (ICP) and adverse event (AE) reduction programs focused on blood transfusion, venous thromboembolism (VTE), ineffective pain management, and more.

Since its inception (January 2018), this blog's following has been growing steadily. We would like to take the opportunity to thank our readers for their participation, contributions, and feedback. Currently, 5,000 health care professionals receive the American Joint Replacement Registry (AJRR) Blog by email weekly. Others access it though the AJRR website, via a keyword search on the Internet, or on Twitter. Our audience consists of AJRR participants/subscribers, other AJRR stakeholders, and institutions that have indicated an interest in joining AJRR. 

Most Popular Content 

Blog content is chosen to address diversified, sometimes controversial, clinical and registry issues/opportunities. Some of the most popular topics deal with translating registry findings into clinical practice. The selection criteria for our most popular blogs-to-date (Top 5) are based on number of views, submitted comments, and reader follow-up requests. In case you've missed any of the Top 5 blogs as identified by the actions of your peers, access them below. You can also share past blogs that may interest your colleagues with the social media icons below the title of each blog post.

As the Electronic Health Record (EHR) becomes the primary interface for physicians and other health care workers, the American Joint Replacement Registry (AJRR) must increasingly work through EHRs for greater interoperability to be achieved.

Providers’ EHR Challenges

Today many hospitals, ambulatory surgery centers, and clinicians’ offices use more than one data capture system. In other words, more than one EHR within a single provider system may be utilized to support registries like AJRR. As a result, data capture can be awkward and time consuming for clinicians and their staff. While some of this can be overcome without interoperable systems, for example by uploads from these systems to AJRR of specific standard file formats, AJRR continues to pursue improvements aligned with the overall industry effort.

June is National Safety Month. For the American Joint Replacement Registry (AJRR), part of the American Academy of Orthopaedic Surgeons (AAOS) Registry Program, every month is safety month. Many registries around the world began with a mission of monitoring patient safety factors, including medical devices. Over the years, their missions have expanded to include broader data-driven, quality improvement efforts.

William J. Robb III, MD, AAOS TeamSTEPPS mentor, said, “Without safety, there is no quality or value; safety is the kernel around which all else is built.”