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VBCR - April 2015, Volume 4, No 2 - Health Economics
Alice Goodman

The most comprehensive database in the United States on total hip and knee joint replacements (TJRs) and outcomes establishes benchmarks for these surgeries and offers new insights into appropriateness criteria and timing of surgeries that will enable value-based care.

Called FORCE-TJR (Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement), the database is the culmination of a 4-year, $12-million project funded by the Agency for Healthcare Research and Quality.

“Total hip and knee joint replacements are…the greatest expense of the Medicare budget. The FORCE database is the first to allow independent assessment of total joint replacement effectiveness in terms of both implant performance and improvement in patient pain and physical function,” stated FORCE-TJR steering member Joan A. McGowan, PhD, in a news release dated March 23, 2015. McGowan is the director of the Division of Musculoskeletal Diseases at the NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Research findings from the database, presented at the 2015 American Academy of Orthopedic Surgery meeting in March, include the following:

  • Optimal timing for joint replacement can now be determined by comparing patient pain and disability scores with national benchmarks. The database shows “remarkable consistency in the level of pain and disability among TJR patients—but timing is important and waiting too long or having surgery too early may not achieve the highest level of improvement post surgery.”
  • Risk factors are accounted for so that surgeons can use the database’s risk-adjustment methods to compare their patients to national data and adjust patient selection criteria for optimal outcomes and patient care.
  • More than 40% of all TJR patients are under the age of 65, and this is the fastest-growing population for these procedures. For the first time, FORCE-TJR shows that patients under the age of 65 have more musculoskeletal risk factors, such as multiple painful joints or low back pain, than does the Medicare population. Fortunately, these younger patients can enjoy comparable levels of pain relief from TJR and functional outcomes that can improve quality of life.

The cohort for the database included more than 30,000 diverse TJR patients treated by a consortium of US surgeons from representative practices. FORCE-TJR includes traditional collection of data on implant-device failure and repeat surgeries, and in addition, it is the first TJR database that includes patient-reported outcomes on measures of pain and function pre- and postsurgery, as well as readmission and infection rates, adverse events, clinical comorbidities, and other patient risk factors and demographics that may influence outcomes.

“The combination of these outcome data plus costs can be instrumental for informing value-based purchasing analysis and decisions,” stated Catherine MacLean, MD, PhD, in the news release. MacLean is with HealthCare Value Solutions and is the former staff vice president of Clinical Quality,
Anthem Inc.

FORCE-TJR plans to expand the enrollment of surgeons and hospitals in the database. The database not only allows access to national TJR benchmarks, but also provides real-time patient reported outcome scoring and comparative feedback from practices that will improve patient care, meet reporting requirements, allow comparison of performance among peers and institutions, and secure quality incentive payments.

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Last modified: June 26, 2015
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