David Ayers, Patricia Franklin highlight value of patient-reported outcomes registries in NEJM Catalyst

Orthopedics outcomes researchers showcase FORCE-TJR registry as model

By Sandra Gray

UMass Medical School Communications

November 02, 2018
  Patricia Franklin, MD, MBA, MPH, and David Ayers, MD

Patricia Franklin, MD, MBA, MPH, and David Ayers, MD

A new analysis by UMass Medical School orthopedic outcomes researcher Patricia Franklin, MD, MBA, MPH, and orthopedic surgeon David Ayers, MD, affirms the value of patient-reported outcomes registries. Published in the New England Journal of Medicine Catalyst on Oct. 31, the article explains why and how patient outcome registries like Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR), which they established in 2010, are essential to informing health policy and treatment decisions.

Dr. Franklin, professor of orthopedics & physical rehabilitation and family medicine & community health, and Dr. Ayers, the Arthur M. Pappas, MD, Chair in Orthopedics and chair and professor of orthopedics & physical rehabilitation, explain that registries like the FORCE-TJR database complement electronic health records data for quality and value monitoring and comparative outcomes research. This is increasingly important as today’s health care industry shifts from fee-for-service payment to bundled payment programs linked to the quality of care and long-term outcomes, they said.

“Well-designed registries engage patients as partners to ensure comprehensive, consistent data to inform quality and outcome monitoring beyond the electronic health records of a single hospital or health system,” said Franklin. “Smartly designed registries do not duplicate the EHR’s clinical data but rather augment this information to serve ongoing quality improvement, policy and research efforts.”

The FORCE-TJR web-based data infrastructure captures and analyzes information from patients who had knee or hip replacements about how they fared in the months and years following their surgeries. It is the most comprehensive U.S. database on total hip and knee joint replacement patients, including patient-reported outcomes as well as surgical and implant data, with more than 50,000 patients from more than 200 orthopedic surgeons in 28 states enrolled.

The article details how web-based portals such as those deployed by FORCE-TJR facilitate data collection on pre- and post-hospital care and outcomes across time and place; how registry staff engage patients to capture complete data; how registries like FORCE-TJR establish national benchmarks for patient data; why patients are a key resource for information; and how patient-centered registries do not duplicate, but rather augment, electronic health records.

“Data from both electronic health records and longitudinal patient registries are central to implementing, managing and monitoring health care in emerging value-based models,” said Ayers. “High-quality longitudinal patient-reported and clinical data collected in FORCE-TJR can be aggregated to complement EHR data, engage patients and simultaneously used as a management tool to improve performance in value-based payment populations.”

Elise Berliner, PhD, director of the technology assessment program at the Center for Outcomes and Evidence in the U. S. Agency for Healthcare Research and Quality, co-authored the article with Franklin and Ayers. NEJM Catalyst brings health care executives, clinical leaders and clinicians together to share innovative ideas and practical applications for enhancing the value of health care delivery.

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