Improving joint replacement

Transcription

1 Improving joint replacement The National Joint Registry for England, Wales and Northern Ireland nts surgeons nhs hospitals independent sector healthcare profe ctors nurses regulators commissioners implant suppliers patient ons nhs hospitals independent sector healthcare professionals rses regulators commissioners implant suppliers patients surgeo hospitals independent sector healthcare professionals doctors n ulators commissioners patients surgeons nhs hospitals indep r healthcare professionals doctors nurses regulators commissio nts surgeons nhs hospitals independent sector healthcare profe ctors nurses regulators commissioners patients surgeons nhs itals independent sector healthcare professionals doctors nurses lators commissioners patients surgeons nhs hospitals indepen r healthcare professionals doctors nurses regulators commissio nts surgeons nhs hospitals independent sector healthcare profe ctors nurses regulators commissioners patients surgeons nhs itals independent sector healthcare professionals doctors nurses lators commissioners patients surgeons nhs hospitals indepen r healthcare professionals doctors nurses regulators commissio nts surgeons nhs independent sector healthcare professionals d

2 NJR in numbers 1 Steering Committee, supported by expert sub-committees 1 NJR Patient Network 3 Our contribution to improvement in joint replacement surgery UK territories covered, collaborating internationally NJR mission statement: 3 Advanced feedback services for surgeons, hospitals and suppliers Published Annual Reports since 2004 The purpose of the National Joint Registry for England, Wales and Northern Ireland is to collect high quality and relevant information about joint replacement surgery in order to provide early warning of issues relating to patient safety. In a continuous drive to improve the quality of outcomes and ensure the quality and cost effectiveness of joint replacement surgery, the NJR will monitor and report on the outcomes and support and enable related research. 1,000s of colleagues across the NHS and independent orthopaedic sector 5 Joint replacement procedures recorded 100s of research papers and scientific posters using NJR data 1,850,000+ records and growing The National Joint Registry (NJR) has grown significantly since its inception in 2002, collecting and monitoring data on the hundreds of thousands of hip, knee, ankle, elbow and shoulder operations that take place each year. The registry, by applying appropriate and robust methodologies to this information, provides the orthopaedic sector with a measurement of joint replacement implant survivorship. These insights, within a rich pool of supporting data, provide a robust evidence-base for best practice and poor practice in orthopaedic surgery. Through the provision of world-leading online feedback services and publication of high-profile research, the NJR continues to support the long-term improvement of implants, hospital services and surgical practice. Over the next decade, the potential for the registry s impact grows even further. NJR s data is supporting national initiatives Getting It Right First Time and world-first patient safety projects Beyond Compliance. The registry has adopted a progressive economic model that will, through subscription, ensure a fairer burden of costs to the NHS and enable cost-savings through an implant price-benchmarking service. Importantly, there will be an ever-increasing link to patient reported measures of outcome and experience so that we can help build a broader picture of success in joint replacement.

3 Achievements since NJR establishes as the data collector for joint replacement procedures in England and Wales Lord Philip Hunt, Parliamentary Under Secretary of State for Health (Lords): The National Joint Registry provides an exciting opportunity to understand more about the performance of hip and knee implants, improve surgery through learning from best practice, and essentially, improve the quality of care to patients NJR starts recording hip and knee replacement procedures, supported by the British Orthopaedic Association (BOA), British Hip Society, British Association for Surgery of the Knee and the Royal College of Surgeons of England (RCS) NJR Regional Coordinators establish their role working with hospitals on improving the volume and quality of their operation data submissions as well as supporting the patient consent process NJR Regional Clinical Coordinators (orthopaedic surgeons) established to help grow understanding of registry process and findings First development of the outlier monitoring process where information is examined closely to identify poor performance for implants, hospitals and surgeons. This process has since been developed by the NJR in partnership with the BOA, the Medicines and Healthcare Products Regulatory Agency (MHRA) and Association of British Healthcare Industries Collaboration with the Orthopaedic Data Evaluation Panel and National Institute for Care Excellence begins getting NJR data to work alongside other national standards and requirements NJR StatsOnline a website facility for viewing and downloading NJR statistics launches and is open to everyone NJR ReportsOnline within the data entry system launches to provide surgeons and hospitals with information about their operations, patients and use of implants The NJR website () is developed to act as a hub for the growing number of information resources available

4 Management of the NJR was transferred from the Department of Health, to the Healthcare Quality Improvement Partnership ( NJR Clinician Feedback a secure, surgeon-only data website launches. Surgeons are able to view reports, indicators and outcomes for procedures recorded in their name ( NJR s extended Patient Reported Outcome Measures (PROMs) are agreed for a group of 50,000 hip and knee patients. Overseen by the NJR Research Sub-committee, these patients will be contacted at one, three and five years after their operation to ask for their views about the surgery and its success NJR Supplier Feedback a world first, secure website supporting manufacturers in the monitoring of their own implant products launches NJR starts recording ankle replacement procedures, supported by the British Orthopaedic Foot and Ankle Society NJR Implant Performance Sub-committee reports concerns of early failure rates for metal-on-metal hip replacements to government body the MHRA The first NJR Fellowship programme establishes to enable greater research into joint replacement. A rolling NJR-RCS England programme is now running Data submission to the NJR becomes mandatory (NHS Standard Contract) NJR publishes its first Public and Patient Guide to the Annual Report working with patients to create more patient-friendly information NJR starts recording elbow and shoulder procedures, supported by the British Elbow and Shoulder Society The House of Commons Science and Technology Committee states that the NJR should serve as the gold standard for implant registries as part of their regulation of medical implants in the EU and UK report. NJR establishes its Patient Network to bring patient ideas and comments to the heart of ongoing projects and publications Significant research on stemmed metal-on-metal and resurfacing hip replacements publishes in The Lancet and BMJ NJR Surgeon Outlier Sub-committee publishes Annual Clinical Reports to hospitals. Along with the secure NJR Management Feedback website, these reports give hospitals a picture of their performance based on the data they have reported to the NJR

5 NJR extends to Northern Ireland NJR hosts the International Society for Arthroplasty Registries (ISAR) second annual congress in the UK NJR publishes consultant surgeon-level information for the first time at in partnership with the BOA, specialist surgical societies, HQIP and NHS England Overseen by the Editorial Board, the 10th Annual Report publishes Benchmarking Award win for the NJR joint replacement implant pricing pilot study, completed in partnership with the Department of Health NJR moves into its second decade of data collection NJR implements its revised funding model, reducing through subscription, the overall cost burden to the NHS. This includes sharing operational costs appropriately with implant suppliers A price-benchmarking service for the NHS supply chain launches, to enable hospitals to examine the relationship between quality and the cost of joint replacement implants Work to support national initiatives Getting It Right First Time and Beyond Compliance continues through provision of NJR data and analysis International collaboration grows through membership of the ISAR, the International Consortium of Orthopaedic Registries (ICOR) and through the international classification system for orthopaedic devices using Unique Device Identifiers (UDI) NJR s Annual Report information moves online to a new dedicated website ( with interactive reporting Future plans Implementation of NJR Data Quality Strategy initiatives and a national data validation programme to be completed in partnership with hospitals Launch of enhanced hospital-level information through the NJR s Surgeon and Hospital Profile service, detailing patient improvement and outcomes measures Development of the research programme through the NJR Research Strategy, with plans to increase access to data through an NJR annual databuild for approved researchers via a secure online platform Active work to facilitate the harmonisation of joint replacement component classifications across global orthopaedic registries

6 Focus on NJR Patient safety and patient outcomes The NJR will continue to improve methods to collect, verify and monitor data as well as identify areas of good practice and poor performance. Data quality is a keen focus and the NJR will be examining new ways to support hospitals in achieving the required standards of data submission, completeness and accuracy as well as validating their data in the NJR through initiatives as part of an overall Data Quality Strategy. Maintaining and strengthening professional relationships across the orthopaedic sector will too enable the success of innovative projects and partnerships. NJR data is an integral part of the national professional review Getting It Right First Time, examining the best and most cost-effective way of achieving high quality orthopaedic care and; Beyond Compliance, a world-first initiative assessing more closely the entry of new joint replacement implants into the UK market. These national collaborations will continue to grow, along with the merits of the international surveillance of joint replacement surgery through ISAR, ICOR and the UDI. Supporting information availability Further advancement of the NJR s worldleading online feedback services will continue to ensure that timely information is provided to meet the needs of surgeons, hospitals and suppliers. The new NJR Reports website will continue to increase accessibility to the registry s annual report data and aims to build on its early interactive functionality. Growing the NJR Patient Network will be a crucial part of building on and developing patient-specific resources. Focus here is on the Public and Patient Guide and NJR Surgeon and Hospital Profile, a world-first in the publication of orthopaedic consultant surgeon and hospital activity and outcomes. This will continue to develop under NHS England s transparency programme, as will collaboration with NHS Choices. Other key developments in this area will include encouraging use of and monitoring outcomes from the implant pricebenchmarking service. Facilitating research Expanding the ways in which NJR data is used for and within research is another important focus with the refreshed Research Strategy now complete. Research maximises the registry s ability to evidence trends and techniques that could improve outcomes and experience for joint replacement patients. The NJR Research Fellow programme will continue, complemented by a streamlined research application process. Analysing the national and extended NJR PROMs programme will be increasingly important, in order to complement survivorship analysis (how long implants last) with patient-reported measures of success. Governance and leadership The NJR s governance structure is too progressing to increase efficiency and responsiveness. In addition to new NJR Steering Committee (NJRSC) appointments, the registry is delighted to have a Medical Director to strengthen clinical leadership, supported by a new Medical Advisory Committee. The NJRSC is now also supported by a new Executive Committee, strengthening its operational decisionmaking capability.

7 As the National Joint Registry moves into the next ten years of growth and development, so too does the richness of data and information at its heart. In the years to come, this unrivalled evidence-base will enable the NJR to protect patients and support surgeons, hospitals and suppliers in new and innovative ways. We are proud to work alongside all our colleagues in the orthopaedic sector to continue to drive forward quality in joint replacement surgery. Elaine Young Director of operations for the NJR at the Healthcare Quality Improvement Partnership To find out more about the NJR: Visit our website at as well as our online resources at and Call the NJR helpline on Send an to enquiries@njrcentre.org.uk Write to: NJR Centre, Peoplebuilding 2, Peoplebuilding Estate Maylands Avenue, Hemel Hempstead HP2 4NW National Joint Registry. March 2015.