The Evolving Role of Clinical Registries: Existing Practices and Opportunities for Orthopaedic Surgeons.

Abstract

Orthopaedic surgery has historically been a leader in using clinical data registries (CDRs) to improve the effectiveness of care, primarily relating to arthroplasty. The Patient Protection and Affordable Care Act (PPACA) has dramatically altered the quality-reporting landscape in the U.S., and registries are now at the center of several intersecting national health policy initiatives. Moreover, other surgical specialties have established registries with proven success in improving care quality, and lessons can be learned from these efforts. In order to effectively utilize registries for innovation, quality assessment, and demonstration of value, orthopaedic surgeons need a clear understanding of how registries and mandated quality reporting are increasingly linked. CDRs prospectively track outcomes among patients with a unifying disease or treatment. Over the past decade, CDRs have been expanded to include overlapping roles in health services research, quality improvement, and now pay-for-performance initiatives. The Physician Quality Reporting System (PQRS) implemented by the Centers for Medicare & Medicaid Services (CMS) has begun attaching financial incentives to CDR reporting to increase physician participation in national quality-improvement efforts1. An up-to-date knowledge of developments in CDR creation and utilization is vitally important for orthopaedic surgeons. CDR participation can meaningfully contribute to increasing value in musculoskeletal care through quality improvement and cost-effectiveness research, in addition to complying with payer mandates. The evolution of CDRs has been shaped by several landmark health-policy changes during the past decade. The Institute of Medicine’s reports on patient safety and health-care disparities in the early 2000s forced stakeholders to examine the quality and variability of care delivered to patients2,3, while the PPACA brought the issues of cost containment and value to the forefront4. Accordingly, the structure and goals of registries have been expanded to meet these objectives. Within orthopaedic surgery, CDRs have historically been used …