Institute for Healthcare Improvement Seeks Progress in Total Joint Replacement

Cambridge, MA – The Institute for Healthcare Improvement (IHI) has formed a Joint Replacement Learning Community, bringing together 32 medical centers worldwide with expertise in joint and orthopedic medicine to look at ways to improve costs and patient outcomes associated with total hip and knee joint replacement.

The organizations and surgeons participating in the IHI program are seeking the adoption of new methods that will improve outcomes per dollar spent on knee and hip replacements. Participants in the Joint Replacement Learning Community are identifying and acting on process improvement opportunities through the application of cutting-edge costing techniques, standardized outcome measures and process improvement strategies.

“In order to measure value and implement the concept of improving outcomes, decreasing costs and ultimately improving patient value, it is critical to measure outcomes most important to patients,” said Dr. David Ayers, MD, chair of the Department of Orthopedics and Physical Rehabilitation at UMass Medical School. “Tracking the administering of antibiotics on time are one step, keeping track of the success of an implant device is another, but we can do better.  We need to include the patient’s voice on their outcomes in regards to both pain and function.”

Dr. Ayers also serves as co-lead of Function and Outcomes Research for Comparative Effectiveness of Total Joint Replacement (FORCE-TJR), a new national database funded by a $12 million grant from the Agency for Health Care Research and Quality.  FORCE-TJR collects outcomes data on knee and hip replacements from 136 surgeons in 22 states, and has enrolled 20,000 patients to date, with a planned total enrollment of 30,000.

FORCE-TJR surgeons consistently gather validated PROs from their patients pre- and post-surgery.  The FORCE-TJR database is the largest to provide measureable patterns of patient pain, function, mobility, and other health indicators.

With a 95% PRO collection rate,  Ayers presented FORCE-TJR’s best practices in PRO collection to the IHI Learning Community and the ways in which UMass Medical uses FORCE-TJR to successfully capture and calculate outcome data. At this time, FORCE is enrolling new participants.

As joint replacement rapidly becomes one of the most common and costly surgeries in the nation, the IHI Joint Replacement Learning Community will help providers who are facing increased challenges in areas such as:

          Transparency, especially as evidence increases showing widespread variation in cost and quality

          Assessment of the critical aspects of care

          Quality care improvement due to the present shortage of standardized and comparable information regarding outcomes and cost

          Knowledge of where they stand relative to their peers

          Properly calculating the cost (as opposed to the billing charges) of the care they provide


FORCE-TJR – Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement – is federally funded by a $12 million grant from the Agency for Healthcare Research and Quality (AHRQ). The research program is developing a national database of surgical results and patient-reported outcomes that will include at least 30,000 TJR patients. FORCE-TJR is both a research program to develop new knowledge about best practice, as well as a quality monitoring system that provides immediate data to surgeons and hospitals to manage and monitor outcomes.The research, along with recorded patient assessments about the success and failure of their surgeries, will ultimately guide and improve clinical best practices, health care policy and the overall health and quality of life for millions of people suffering from arthritis.

Josh Sandberg

Josh Sandberg is the President and CEO of Ortho Spine Partners and sits on several company and industry related Boards. He also is the Creator and Editor of OrthoSpineNews.

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