California Joint Replacement Registry (CJRR)

Update: In March of 2015 the California Joint Replacement Registry (CJRR) merged with the American Joint Replacement Registry (AJRR). The goal of the merger is for AJRR to apply the CJRR patient-reported outcome data collection model to other parts of the country. “Since CJRR’s founding in 2009, we have always had the vision that CJRR would become part of the national total joint replacement registry effort when mature,” said Kevin Bozic, MD, MBA, founding chair of CJRR and vice chair of AJRR in a statement. “This union will allow AJRR to capitalize on the expertise in measuring patient-reported outcomes that we have developed in California over the past six years, and allow Californians to have an impact on the national effort to improve total joint replacement patient outcomes.”

Founded in 2009, the California Joint Replacement Registry (CJRR) was created to help surgeons, hospitals and their patients identify and utilize important information about the outcomes of Hip and Knee Replacement surgeries.

CJRR is a collaboration of the California HealthCare Foundation, the Pacific Business Group on Health, and the California Orthopedic Association. There are currently 41 hospitals and 225 surgeons across the state of California who participate in the registry.

There are several aspects of the CJRR that make it unique. In addition to clinical information, CJRR collects information directly from patients about how they are functioning both before and after surgery by using validated patient-reported outcome tools. It was one of the first Level III orthopedic data registries in the nation.

Another unique aspect of the CJRR is the methodology used to collect data. Rather than using a data abstractor to pull information for the patient charts and manually enter the data to the registry, CJRR pulls the data electronically directly from the hospital and providers EHR. To help facilitate PRO data collection, the CJRR automatically prompts patients via email to complete the surveys prior to their surgery to assess a baseline, and then again 12 months after their surgery to assess their progress. When the patient completes the online patient reported outcome survey, the responses are uploaded automatically to CJRR. Quarterly reports are sent to participating hospitals and providers that show their performance compared to registry benchmarks.

In November 2014, the CJRR released its first progress report that presented the registry’s findings for the first two years of data collection (2011-2013), including information from about 5,100 hip and knee replacement surgeries from nine participating hospitals and 61 surgeons. Among the observations in California Joint Replacement Registry: Progress Update:

• Data suggests that California is following national trends, with more and more patients having joint replacements and (on average) having them at a younger age.
• Patients undergoing surgery at hospitals participating in the CJRR report improvements in pain and function (the CJRR is one of the few multi-institutional registries in the US to measure these outcomes).
• Consistent with national trends, patients with knee or hip arthritis who undergo surgery at hospitals participating in the CJRR often have other medical conditions that make their operations more challenging. For example, 35% of CJRR patients fit the Centers for Disease Control and Prevention’s definition of obesity.
• A majority of patients who have hip or knee replacements at hospitals participating in the CJRR have a hospital stay of fewer than three days.