Federally Funded Project Establishes First National Database of Comprehensive Benchmarks for Total Hip and Knee Joint Replacement

Worcester, MA – A 4-year, $12 million national research project funded by the Agency for Healthcare Research and Quality (AHRQ) has surpassed its original goal, culminating in the establishment of the most comprehensive U.S. database on total hip and knee joint replacement patients and their surgical outcomes.

“Total hip and knee joint replacements are the most common inpatient surgical procedures performed in the U.S., and the greatest expense of the Medicare budget,” says FORCE-TJR steering committee member Joan A. McGowan, PhD, Director of the Division of Musculoskeletal Diseases at the NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases. “The FORCE database is the first to allow independent assessment of total joint replacement effectiveness in terms of both implant performance and improvement in patient pain and physical function.”

The project and resulting database, called FORCE-TJR, is the first on total joint replacements (TJR) to identify risk-adjusted national benchmarks, including patient risk factors, and other clinical measures, to guide surgeon and patient decisions regarding timing of surgery and optimal patient selection.

According to Catherine MacLean, MD, PhD, of HealthCare Value Solutions, former Staff Vice-President of Clinical Quality, Anthem, Inc., “The combination of these outcome data plus costs can be instrumental for informing value-based purchasing analyses and decisions.”

Research findings that will be presented at the upcoming American Academy of Orthopedic Surgeons annual meeting (March 24-28) include:

• Optimum timing for hip and knee replacement surgery – patient pain and disability scores now can be compared to national benchmarks when discussing the timing for surgery with potential patients.  National benchmarks identified by FORCE-TJR data show that while there is remarkable consistency in the level of pain and disability among today’s TJR patients, those who wait too long, or have surgery too early, may not gain the highest level of improvement after TJR.

• Comparisons of patient risk factors and outcomes – FORCE-TJR data documents that post-surgery patient pain and function, and readmission rates, are influenced by a number of pre-operative patient risk factors. FORCE-TJR’s risk-adjustment methods account for varied patient factors so surgeons can, for the first time, compare their patients’ risk factors to national data and adjust, if needed, their patient selection criteria for optimal outcomes and patient care.

• Outcomes data on working-aged adults – Individuals under the age of 65 make up more than 40% of all TJR patients – and are the fastest-growing patient population for TJR.  Prior to FORCE-TJR, outcome information was available only for Medicare-eligible patients (over 65).  FORCE-TJR data shows, for the first time, that patients younger than 65 have more musculoskeletal risk factors such as multiple painful joints or low back pain than older patients. However, these younger patients can expect comparable levels of pain relief and functional outcomes that may benefit their overall quality of life.

A consortium of more than 150 surgeons from representative practices across the U.S., led by researchers at the University of Massachusetts Medical School, collected information from more than 30,000 diverse TJR patients to establish a statistically significant cohort for the AHRQ-funded database.  FORCE-TJR goes beyond the traditional collection of information on only implant device failure or repeat surgeries.  It is the first U.S. TJR database to include PROs - patient-reported measures of pain and function pre- and post-surgery, as well as clinical measures such as readmission and infection rates, adverse events, clinical co-morbidities and other patient risk factors and demographics that may influence patient outcomes.    

“With this data, for the first time, we can compare patients’ physical outcomes with varied implants, surgical approaches and follow-up programs. We have benchmarks to use to see where our patients fall on a national spectrum both pre- and post-surgery,” says Dr. David Ayers, MD, co-lead of FORCE-TJR and chair of the Department of Orthopedics and Physical Rehabilitation at UMass Medical School. “The data is invaluable for developing best practices.”

FORCE-TJR is now serving as a comprehensive orthopedic registry, expanding to enroll surgeons and hospitals beyond the original AHRQ-funded cohort.  In addition to providing access to national TJR benchmarks, the FORCE-TJR registry provides real-time patient-reported outcome scoring and comprehensive, comparative arthroplasty practice feedback and data to improve patient care, meet reporting requirements, compare performance to peer surgeons/institutions, and secure quality incentive payments.

“The research on the original AHRQ-funded cohort will continue indefinitely as we implement annual follow-ups with those patients,” says Patricia Franklin, MD, PI, AHRQ grant and professor of Orthopedics and Quantitative Health Sciences at the UMass Medical School.  “The data we’ve collected, and continue to add to, has the potential to directly influence clinical best practices, health care policy and the overall health and quality of life for more than 60 million people in the U.S. living with arthritis.”

About FORCE-TJR

The FORCE-TJR registry provides enrolling surgeons and hospitals comprehensive, comparative arthroplasty practice feedback and data on total joint replacement (TJR) to improve patient care, meet reporting requirements, compare performance to peer surgeons/institutions, and secure quality incentive payments.  FORCE (Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement) data and methods, as well as risk-adjusted national comparative benchmarks, were established under a $12 million grant from the Agency for Healthcare Research & Quality that involved more than 150 surgeons representing all practice settings (e.g., urban and rural, high and low volume), and regions of the U.S. For more information or to enroll, find us at http://www.force-tjr.org/.