Inroads made tracking patient progress

We agree with Dr. Kevin Stone's call for improved tracking and surveillance of surgical procedures and devices (“How informed are doctors?” Features, Nov. 2).

As he notes, registries, which are large databases that allow researchers, physicians and other health care stakeholders to compare the effectiveness of surgical procedures, drugs, devices and other health care interventions, are a critical part of the solution to this lack of tracking and evaluation.

However, Dr. Stone omits to mention that there has been great progress to create and implement registries in the field of hip and knee replacement.

In California alone, there are two major registries: The California Joint Replacement Registry and the Kaiser Permanente Implant Registry, both of which track the effectiveness of the surgical approaches, devices and other factors.

In addition, the California Joint Replacement Registry directly asks patients for their input about their pain and function both before and after surgery, on an ongoing basis, and provides this feedback to their surgeons.

The California Joint Replacement Registry will begin to report data publicly about the results of hip and knee replacement surgeries at its participating hospitals in early 2015. In the meantime, patients who are interested can see results for Medicare patients at www.calqualitycare.org or at www.hospitalcompare.gov.

In addition, the only national registry for hip and knee arthroplasty (surgical repair of a joint) is the American Joint Replacement Registry (www.ajrr.net).

Since 2010, the AJRR has been collecting data nationwide across all demographics and 48 states, resulting in a robust registry collecting patient, procedural and device information. To date, the registry has more than 125,000 procedures collected from nearly 400 hospitals. This data can be used for self-assessment, individual provider and hospital-level quality reporting and benchmarking.

All of these efforts are critical investments in the safety and effectiveness of health care, and will allow the provision of the most effective and cost-conscious care to the increasing number of patients who suffer from disabling arthritis of the hip and knee.

The author says more should be done to help inform doctors, and we'd like to inform Dr. Stone that there are orthopaedic registry resources already available to use today. These registries are built on sound methodologic principles and secure technology that connects with institutions' electronic medical record systems. The registries are based on collaboration among multiple healthcare stakeholders, including major device manufacturers, orthopaedic surgeon leaders, the Food and Drug Administration, and the Centers for Medicare & Medicaid Services.

We would encourage Dr. Stone to participate in these registry efforts which have the potential to improve the value of care we provide to patients who undergo hip and knee replacement procedures.

William J. Maloney, professor of orthopaedic surgery at Stanford University, is chairman of the American Joint Replacement Registry and Kevin J. Bozic, professor and vice chair of orthopaedic surgery at UC San Francisco, is chairman of the California Joint Replacement Registry.

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