American Joint Replacement Registry Today & Tomorrow: Q&A With Director of Research Dr. Caryn Etkin

Orthopedic Sports Medicine

Caryn Etkin discusses AJRRThe American Joint Replacement Registry is an initiative to improve quality, outcomes and cost-effectiveness of total joint replacements. Today, the registry has contracts with 51 institutions representing 72 hospitals. With current sites, the registry has gathered data on more than 30,000 procedures. "There are around 750,000 total joint replacements in the United States today, but it's estimated to grow to more than a million over the next few years," says Caryn D. Etkin, PhD, MPH, director of research for the American Joint Replacement Registry. "The U.S.  numbers are huge and if you look at the procedure volumes of the existing national registries, the shear volume of US procedures provides increased potential for improving the outcomes of orthopedic procedures.  ."

The registry can perform several different functions, such as tracking implant survivorship and quality outcomes. Here, Dr. Etkin discusses how hospitals and surgeons can benefit from AJRR and where the registry is headed in the future.

Q: What does the American Joint Replacement Registry offer individual hospital and surgeon participants?


Caryn Etkin:
As one of our primary goals is to provide quality metrics, we are able to provide national and state benchmarks, or benchmarks against other de-identified hospitals of similar sizes. That is something hospitals find very important. While some hospitals have their own individual registries, they can track what they are doing but they can't see comparisons to their peers. For hospitals that don't have their own registry, we can serve as their internal registry and our software can provide data back to the orthopedic or quality departments.

Individual surgeons can see how they are performing against others, even their own colleagues at the hospital. The individual data is de-identified so surgeons can see where they stand. The system can monitor how well they are doing and they can also get more information from their own patients in an aggregated way.

Q: Where are efforts in building this registry right now?

CE:
We are a level one registry collecting data strictly on the procedure, so we have information about the patients, implants, surgeons and hospitals. As we move into level two and level three, which we are planning in 2013, we'll be able to provide much more useful information for patient reported outcomes. Right now you could get the metrics on the number of procedures performed and which implants were used, but with level two data we can do risk adjustment for surgeons. They will be able to see the severity of the patients they are working with and whether complications are likely to arise.

Level three data includes patient reported outcomes with quality of life information. Patients will be reporting on how they are doing in the months after surgery.

Q: How will the registry collect patients' outcomes data? Will it be dependent on the hospital to collect that data and insert it or will AJRR follow up with patients?


CE:
We are still working on how the system will be fully operational. We are developing  a mechanism where patients will have an online portal enabling them to go directly into our system to complete surveys. These assessments can also be facilitated by a nurse or other clinical specialist.  

We will be offering levels two and three as a service to hospitals that want to collect this information, but these levels are optional. Some larger health systems collect this data in their internal registries, so they might not need it; others don't and this will be extremely helpful.

Q: Have you found any challenges for hospitals to incorporate the registry? How did you overcome them?


CE:
It's been a challenge to work through the legal department with some hospitals that want to participate in the registry. It's time consuming because the legal department often has many issues they are involved in. We try to work with the hospitals to make the submission of data as easy as possible. There are also many hospitals transitioning to electronic medical records, or updating their EMR, so trying to fit this into the queue is challenging. It's essential to get into the queue for the legal and IT departments early on.

We are willing to work with the hospitals as much as possible. Generally, they are able to extract data from their EMR system and place it into another file format for our system. There are some hospitals that don't have EMR, so we can take that data through a secure web platform. In this instance, it takes a nurse or staff member a few minutes to enter in the patient's information.

Q: What are your goals for the future?


CE:
We are in partnership with many different registries across the United States; collaboration is very critical. We are working with state registries — such as the California Joint Replacement Registry, the University of Massachusetts FORCE-TJR and the Michigan Arthroplasty Registry Collaborative Quality Initiative to develop a system such that any patient who is in their registries could also be in ours.

We are also working internationally with the International Society for Arthroplasty Registries; it represents registries from all across the world. Finally, we are working with members of the International Consortium of Orthopedic Registries, an FDA-funded project that is looking to synthesize data across registries from around the world.

More Articles on Orthopedic Surgery:

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8 Challenges for Spine Surgeons Over the Next 10 Years

Minimally Invasive Total Shoulder Replacements: Q&A With Dr. Anthony Romeo of Midwest Orthopaedics at Rush


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