American Joint Replacement Registry. Jeffrey P. Knezovich, CAE Executive Director ---- Caryn D. Etkin, PhD, MPH Director of Analytics

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1 American Joint Replacement Registry Jeffrey P. Knezovich, CAE Executive Director ---- Caryn D. Etkin, PhD, MPH Director of Analytics

2 AJRR Mission and Vision AJRR is a multi stakeholder, independent, not for profit with diverse national constituents led by top orthopaedists We optimize patient outcomes through collection of data on all primary and revision total joint replacement procedures in the US Our mission is to enhance patient safety, improve quality of care, and reduce the cost of care Our goal is to capture 90% of all total joint replacement procedures in the U.S.

3 Supporters AJRR is supported by hospitals, health insurers, and the following groups:

4 The Official AAHKS Registry AJRR was designated as the official registry of the American Association of Hip and Knee Surgeons (AAHKS) in December The official journal of the AJRR is Arthroplasty Today, an AAHKS publication

5 AJRR History & Milestones 2010 Started Pilot Program with 15 Hospitals 2011 Business Plan Finalized, Funding Secured

6 AJRR History & Milestones 2012 Enhanced Technology to Expand Registry Software 2013 Launched Pilot Program of LII and LIII Platforms with 18 Participating Sites

7 AJRR History & Milestones 2014 All 50 States! 150,000+ Procedures 1 st Audit Complete QCDR Designation by CMS 1 st Annual Report Released ,000+ Procedures User Group Network Formed CJRR merged into AJRR 500 th Hospital Enrolled!

8 We Have Shown Great Progress AJRR Progress Participating Submitting Data Subscription Access [VALUE] 520 Hospitals [VALUE][VALUE] [VALUE][VALUE] Jan April July Oct Jan April July Oct Jan April July Oct Jan 2015 April July Oct Nov Dec Jan 2016 March

9 Where Are We Now? The National Registry September 2014

10 Participating Institution Types Participating Institution Types Hospitals Academic Medical Centers Multiple Health Systems/Networks Ambulatory Surgery Centers Private Practice Groups Solo Practitioners Hospital bed count Small = 1-99 beds Medium = beds Large = 400+ beds Small (22%) Teaching 25% Univ/ Research 11% Rural 9% Large (27%) Community 55% Medium (50%)

11 Cumulative Procedural Volume , , , ,000 Number of Procedures 250, , , ,000 50, , ,975 1,326 2,833 6,730 13,82245, Year

12 AJRR Data Submission Methods 98% of Participants submit a data file upload to AJRR AJRR IT staff works with hospital s IT team to ensure seamless data transmission Report generation and upload to AJRR SFTP site can be automated AJRR process is secure and HIPAA compliant Level I reporting with EMR vendors including Epic, Cerner, Ortech, InVivoLink, MedTrak, URS Oberd, and more Certain vendors have created custom report templates for AJRR data submission

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14 Hip Resurfacing As a Percentage of All AJRR Hip Arthroplasty Procedures by Year

15 AJRR Hemiarthroplasty and Total Hip Arthroplasty Performed for the Diagnosis of Femoral Neck Fracture

16 AJRR Frequency and Percentage of Femoral Head Sizes Implanted by Year

17 AJRR and CJR Hospitals can earn bonus points by voluntarily submitting PRO and risk variable data to CMS AJRR adding CJR related risk variables Patient-Reported Pain in Non-operative Lower Extremity Joint Oswestry Disability Index Patient Reported Health Literacy AJRR provides online PRO capture for VR-12, PROMIS-10 Global, HOOS JR and KOOS JR Reports available to assist with hospital data submission requirements (CMS specific submission requirements TBD) PRO submission will be for the period July 1 August 31, 2016

18 AJRR Level II comorbidity and risk variable data elements Admission/discharge date or length of stay American Society of Anesthesiologists (ASA) score Charlson and Elixhauser comorbidity indices Charnley classification Date of birth Single item health literacy screening questionnaire Height + weight and/or body mass index (BMI) Pain in non-operative lower extremity joint Quantified spinal pain (via Oswestry Disability Index) Race and ethnicity Sex Along with: General comorbidities; Addictions other mental health comorbidities; Cardiac-related comorbidities; Circulatory/vascular comorbidities CJR risk variables

19 AJRR Level II complications HIP and/or KNEE complications Bleeding postoperative requiring surgical Wound Complication treatment Thromboembolic disease Neural deficit Vascular injury Deep periprosthetic joint infection Bearing surface wear Implant fracture Osteolysis Reoperation Implant loosening Revision Death Readmission HIP complications Dislocation / Instability Heterotropic ossification Periprosthetic fracture of the proximal Abductor muscle disruption femur or the acetabulum Cup-liner disassociation KNEE complications Instability Medial collateral ligament injury Stiffness Extensor mechanism disruption Periprosthetic fracture distal femur, Patellofemoral dislocation proximal tibia, or patella Tibiofemoral dislocation Malalignment Tibial insert dissociation

20 Patient Reported Outcomes (Level III) Capabilities In 2015, AJRR launched its Level III/Patient Reported Outcomes platform Recommended measures are in line with CMS and CJR and include: HOOS, JR. KOOS, JR. VR-12 PROMIS-10 Global National benchmarks and dashboards available N=15,384 (75.0%) AJRR s patient portal is a web-based tool for clinicians Other forms available: HOOS, KOOS, Oxford Hip/Knee Score, Knee Society Knee Scoring System, SF-36, Harris Hip Score If entities have a PRO dataset/historical data they would like to submit, AJRR can accept AJRR collaborates with numerous PRO vendors for data submission

21 Training Demonstration Demand Reporting & Electronic Dashboard System

22 AJRR Dashboard

23 AJRR Dashboard

24 AJRR Dashboard Reports

25 AJRR Dashboard

26 AJRR Dashboard

27 AJRR Dashboard

28 AJRR Dashboard

29 AJRR Dashboard

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31 Risk Calculator To access the tool: please visit and click AJRR Risk Calculator under the Quality Initiatives and Tools tab or click here.

32 Thank You! Questions?