AAOS Registry Program Marks Progress and Accomplishments in 2023

It has been more than 6 years since AAOS launched the Registry Program, and the power of registry data is contributing to meaningful changes in orthopaedics. The AAOS family of registries continues its growth trajectory, with more than 3.8 million procedures among five orthopaedic registries. The Registry Program is building on its mission to collect clinical information demonstrating real-world practice, enabling performance measurement, and facilitating quality-improvement programs, as well as supporting scientific research. “The AAOS Registry Program made great strides in 2023 toward elevating the utility of registry data,” said William J. Maloney, MD, FAAOS, Registry Oversight Committee chair. “With a focus on improving the user experience for members and participating sites, new partnerships were formed to support data extraction and submission along with updates to the registry platform that increase transparency into both surgeon- and institution-level registry data. I am looking forward to 2024 and the continued evolution of the Registry Program in support of quality improvement across orthopaedics.”

Surgeons and staff champions at healthcare institutions across the United States collect and submit the data contributing to the national benchmarks and quality measures displayed on the Registry dashboards. As of 2023, more than 12,600 surgeons across more than 1,500 sites contributed data. The Registry Program also receives support from like-minded industry sponsors; in 2023, Lima Corporate, Link, and Exactech became supporters of the AAOS American Joint Replacement Registry (AJRR) in addition to the many sponsors already supporting the registries.

The AAOS Registry Program made great strides last year to advance its offerings based on feedback from its participants. Read on for an update on what the AAOS family of registries accomplished in 2023.

The next generation of AJRR dashboards launched, with improved access to data, analysis, usability, and actionable quality-improvement measures. AJRR and the Shoulder & Elbow Registry (SER) also saw the release of a Data Element Quality and Coverage Dashboard, which provides a visualization of a participating site’s data completeness.

The Registry surgeon dashboards were integrated with AAOS.org, allowing members to conveniently view their Registry data on the AAOS website and eliminating the need to log into RegistryInsights^®. Other improvements included simplifying how members claim Self-Assessment Exam credits for the American Board of Orthopaedic Surgery Maintenance of Certification Part II.

Enhancements were made to individual registries as well. The AAOS Musculoskeletal Tumor Registry (MsTR) dashboards were expanded to display visual representations of data elements captured throughout the patient’s journey, including recurrent follow-up encounters such as complications, recurrences, and additional OR visits.

The next generation of American Spine Registry (ASR) and SER dashboards will be released in 2024, as well as the second phase of the AJRR next-generation dashboards. The ASR is a collaborative effort between the American Association of Neurological Surgeons and AAOS. The Registry Program is working toward the inclusion of an ankle arthroplasty module for AJRR and a spine tumor module for ASR.

AJRR will support data capture and reporting on behalf of sites for the Centers for Medicare & Medicaid Services (CMS) Hospital Inpatient Quality Reporting Patient-Reported Outcome Performance Measure program. Resources are currently available to support sites in preparing for the upcoming requirement.

Support for the Joint Commission Advanced Certifications
AJRR remains the sole pathway for the registry requirement of the Joint Commission Advanced Total Hip and Knee Replacement Certification, and ASR continues to be the sole pathway for the registry requirement of the Joint Commission Advanced Certification in Spine Surgery. Almost 250 sites participating in the Registry Program have obtained their advanced certifications from the Joint Commission, with almost 100 additional participants pursuing their certifications.

In addition to enhancing the Registry platform itself in 2023, the Registry Program enhanced the support options for sites designated with or pursuing the Advanced Certifications. Quick reference guides, toolkits, frequently asked questions, and a designated toll-free number were created, and office hours were held monthly for participants to bring any questions to registry staff about the Joint Commission performance measures.

Reducing the data-submission burden
The Registry Program also expanded its participation options to reduce data-entry burden. AAOS launched a successful technology pilot with the third-party vendor PatientIQ in December 2022 for the Fracture & Trauma Registry (FTR). The partnership yielded a substantial increase in data submitted to FTR in 2023. AAOS continues to add HIPAA-compliant third parties to the AAOS Authorized Vendor Program. A complete list of vendors can be found on the AAOS website.

New MsTR and ASR Epic SmartForm versions launched in 2023 as well. These updated SmartForm versions empower surgeons to input crucial data directly at the point of care, addressing information that cannot be easily extracted from electronic health records.

Registry publications
Registry Program data were utilized in many reports and studies last year. AJRR and SER Annual Reports were published, with an AJRR Annual Report Supplement that assessed the generalizability of AJRR patient-reported outcome measures data. The year 2023 was the 10th anniversary of the first AJRR Annual Report. ASR, MsTR, and FTR published fact sheets that serve as preliminary looks at their data.

Paper presentations and posters utilizing Registry Program data were featured at several conferences in 2023, including the Spine Summit, AAOS Annual Meeting, International Congress of Arthroplasty Registries, Western Orthopaedic Association meeting, and American Association of Hip and Knee Surgeons Annual Meeting. Studies were published in the Journal of the AAOS^® and the Journal of Arthroplasty. SER had its first publication in 2023 in the Journal of Shoulder and Elbow Surgery, “Off-Label Use of Reverse Total Shoulder Arthroplasty: The American Academy of Orthopaedic Surgeons Shoulder and Elbow Registry.”

AJRR collaborated with multiple organizations on studies in 2023. The registry is working with the FDA on a pair of partnership projects investigating the utilization and safety of total hip arthroplasty in high-risk populations, including patients with high BMI and pediatric patients. The Orthopaedic Data Evaluation Panel (ODEP) and AJRR worked together on a study that investigated whether AJRR data are consistent with international survivorship in hip and knee arthroplasty and the feasibility of using AJRR data for ODEP ratings (to learn more, read the article “Registry Study Finds Strong ‘Representativeness’ for AJRR in International Comparison” in the January issue of AAOS Now). As an extension to its Moore Foundation grant, Hospital for Special Surgery is partnering with AJRR to test, self-nominate, and eventually support sites in submitting to CMS as Merit-Based Incentive Payment System measures related to periprosthetic joint infection.

The AAOS Registry Analytics Institute (RAI) also had a successful year. Investigators submitted 66 proposals to RAI for cycles 1 through 3, and 13 proposals were approved for analytics. Additionally, in 2023, AAOS Registry data were featured in more than 40 publications, including 30 abstracts and 13 manuscripts. The publications were presented in more than 10 local, national, and international conferences and six different journals, including a special section in the Journal of Knee Surgery.

Sarcoma awareness
July was Sarcoma Awareness Month, and MsTR published a series of patient and surgeon stories about sarcomas on the AAOS website. Earlier in the year, MsTR Steering Committee Chair Benjamin J. Miller, MD, MS, FAAOS, was featured on the Sarcoma Insight Podcast in an episode titled “Research and Data in Sarcoma Care—Musculoskeletal Tumor Registry,” to discuss the registry’s impact on sarcoma research and care.

Join other leading healthcare institutions in submitting data and engaging with the Registry Program. Together, the orthopaedic community can expand and enhance knowledge while using data to drive improvements in care. Learn more about the Registry Program at aaos.org/registries.

Erik Michalesko is a marketing manager at AAOS. He can be reached at michalesko@aaos.org.