Ortho registry driving care improvements

Orthopedic procedures are particularly vulnerable in the shift to payment bundling as they are highly customizable, yet physicians and orthopedic service line administrators do not have a real-time view of the effectiveness of the specific implants being used in each procedure.

There are several variables that play a factor in the outcome of orthopedic implant procedures: patient characteristics, implant type, implant manufacturer, surgical technique, surgeon and rehabilitation. Clinical registries can provide value for providers who can't track and provide analytics on all this information to ensure their clinical teams are making decisions based on the most robust, detailed information available.

TriStar Health System, an 18-hospital system in Tennessee, Kentucky and northern Georgia, is in the process of implementing a clinical registry for orthopedic procedures. Doug Ardoin, Jr., MD, chief medical officer of TriStar Health System in Nashville, spoke to Clinical Innovation + Technology about the effort.

TriStar's orthopedic surgeons were asking to use a repository, Ardoin said. The tool is loaded into the existing information system so it is available on computers throughout the operating rooms and physicians can access it from their offices over a secure portal.

Surgeons planning joint surgeries enter certain demographic information into the tool along with certain clinical features of their patients. “During and after surgery, they enter more data about the procedure, issues and concerns. Once that’s done, during the postop period, the doctor gets reports from treatment and rehab at certain intervals."

With a large enough database, the organization might be able to look at a cohort of patients based on age or comorbidities. "We might see that diabetic patients in their 70s who undergo total knee replacement have a slower recovery than nondiabetic patients. The hope is that we can begin to mine data and better understand how patients do. What are the issues around a postop course? Based on implant choice, is there a true difference in outcomes? Does a more expensive implant make a difference or not?"

Ardoin said he foresees the repository creating the capability to discover certain things in the OR that don’t add value but only add cost. “We might be able to tease that out and make changes in OR processes. If we discover that more expensive implants don’t supply any substantial benefit, then maybe lower-priced implants are better. We can be more efficient in how we choose which implants in certain cases. In my opinion, it will help us to uncover where we have opportunities to drive better quality of care and better outcomes.”

New, computer-based technology that involves physicians actively working with the system requires lots of education, Ardoin said. “Give them the opportunity to ask lots of questions. They need to understand the benefit. There really is a benefit here to use a registry like this to understand more fully the impact of the care that’s being provided, particularly after surgery and during rehab. [We can get] so much better understanding of the activities and procedures that are truly driving a better outcome and value for the patient versus those that are not.”