AJRR Registry Platform System Workflow Training January 2017
Discussion Topics OVERVIEW: STARTING A PRO PROGRAM AT YOUR INSTITUTION Defining Your Program PROM Collection Workflow Options PART 1: REGISTRY PLATFORM OVERVIEW System Roles Overview Platform Solution Overview Platform Features/Function Overview PART 2: VIEWING & ACCESSING YOUR DATA Data Mart Dashboards PART 3: PRO PROGRAM ONBOARDING DECISIONS Configuring the System to Support Your Institution s PRO Program PART 4: SYSTEM WALKTHROUGH-ADMINISTERING YOUR PRO PROGRAM Registry Platform & Roles Re-Cap Creating Clinician/Surgeon Accounts Search for Patient Creating a Patient/Case Record Completing a PROM Assessment Patient Clinician/Surgeon Reviewing PROM Results Reviewing Level III Queries
What We Do AJRR is a not-for-profit 501 (3) tax-exempt organization for data collection and quality-improvement initiatives for total hip and knee replacements Our Mission: To focus on improving care for patients who receive hip and knee replacements. By collecting and reporting data, AJRR provides actionable information to guide physicians and patient decision making to improve care. It empowers health care organizations to enhance the patient experience and benchmark performance; orthopaedic surgeons to reduce complications and revision rates; device manufactures to strengthen post-market surveillance; and health plans to effectively manage costs.
Participating Institution Types Who Participates in the AJRR? INSTITUTION TYPES: Hospitals Academic Medical Centers Multiple Health Systems/Networks Ambulatory Surgery Centers Private Practice Groups Solo Practitioners Non- Teaching Teaching 25% (43.3%) Rural 9% Major Teaching (21.0%) Minor Teaching (35.6%) HOSPITAL BED COUNT: Small = 1-99 beds Medium = 100-399 beds Large = 400+ beds Large (30.9%) Medium (48.0%) Small (21.1%)
OVERVIEW: STARTING A PRO PROGRAM AT YOUR INSTITUTION Defining Your Program PROM Collection Workflow Options
Why Collect PROs? Define Outcomes Based on the Patient s Viewpoint Review Comparative Benchmarks for Your Institution Federal Initiative Compliance Address Internal Research Needs (Quality Improvement, Clinical Trials, etc.)
Which PROMs Instruments Are Accepted by AJRR? Health Related-Quality of Life Measures Measure Acronym Measure # of Administered via Registry Items Platform? National Benchmark Reports Available? VR-12 Veterans Rand 12 Item Health Survey 12 YES Recommended YES PROMIS-10 Global Patient Reported Outcome Measure Information System - Global Health Short Form 10 YES Recommended YES SF-36 Medical Outcomes Study 36-Item Short Form Health Survey 36 YES; System can be configured to replace recommended instrument NO SF-12 Medical Outcomes Study 12-Item Short Form Health Survey 12 NO; AJRR Accepts Final Scores via Data Submission Process NO EQ-5D EuroQol Index and Visual Analog Scale 6 NO; AJRR Accepts Final Scores via Data Submission Process NO
Which PROMs Instruments Are Accepted by AJRR? Disease-Specific Measures Measure Acronym Measure # of Administered via Registry Items Platform? National Benchmark Reports Available? HOOS, JR Hip Disability and Osteoarthritis Outcome Score (HOOS), JR. 6 YES Recommended YES KOOS, JR Knee Injury and Osteoarthritis Outcome Score (KOOS), JR. 7 YES Recommended YES HOOS Hip Disability and Osteoarthritis Outcome Score 40 YES; System can be configured to replace recommended instrument NO KOOS Knee Injury and Osteoarthritis Outcome Score 42 YES; System can be configured to replace recommended instrument NO KSS (Pre-and Post-Op) Knee Society Knee Scoring System 44 YES; System can be configured to replace recommended instrument NO Harris Hip Score Harris Hip Score 8 YES; System can be configured to replace recommended instrument NO Oxford Hip Oxford Hip Score 12 Oxford Knee Oxford Knee Score 12 WOMAC Western Ontario and McMasters University Osteoarthritis Index 24 YES; System can be configured to replace recommended instrument YES; System can be configured to replace recommended instrument NO; AJRR Accepts Final Scores via Data Submission Process NO NO NO
Which PROMs Instruments Are Accepted by AJRR? Other Measure Acronym Measure # of Administered via Registry Items Platform? National Benchmark Reports Available? CJR CMS Risk Assessment 3 YES Recommended YES Coming Soon CollaboRATE California Blue Cross CollaboRATE (California Insitutions Only) 3 YES System can be configured to support addition of this instrument NO UCLA UCLA Physical Activity 1 YES; System can be configured to support addition of this instrument NO
PROMs Accepted Instrument Summary The Registry Platform Supports Data Collection Services for these instruments.. AJRR Recommended Health Related-Quality of Life Measures VR-12 PROMIS-10 Global Disease Specific Measures HOOS, JR. / KOOS, JR. Other CMS Risk Assessment Supported in Registry Platform Health Related-Quality of Life Measures SF-36 Disease Specific Measures HOOS / KOOS KSS (Pre and Post-Op) Harris Hip Score Oxford Hip / Oxford Knee Other UCLA CollaboRATE Final Score Submission Only Health Related-Quality of Life Measures EQ-5D SF-12 Disease Specific Measures WOMAC Other N/A
How Can I Start a PRO Program at My Institution? Define Your PRO Team Define Your PRO Goals Select Measures that support Goals Define Frequency of Data Collection Define Data Collection Workflow For additional resources and information on getting started, visit http://ajrr.net/images/about-ustabs/enroll_with_us/ajrr_proms_guide_2016_final_10-25_final.pdf Or contact us at info@ajjr.net
Define Your PRO Team Engage the core group of colleagues that have decided the inclusion of PROs in your practice of care may provide the information needed to measure and improve patient outcomes. It s also critical to involve stakeholders at each level of patient care consider engaging one or more of the following groups to define holistic and achievable goals: Orthopaedic Department Orthopaedic practice groups and clinics Quality Department Information Technology Orthopaedic Service Line Research Rehabilitation Hospital Administration Patient Advocate/Patient Representative Institutional Review Board (guidance/review)
Define Your PRO Goals Determine your reason for launching a PRO program at your institution G Ask your core group the following exploratory questions to frame your discussion; brainstorm and document your program goals: Are we launching a research initiative with specific aims? Are we seeking comparative benchmarks to our peers? Are we wanting to quantify our outcomes from our patients perspective? Do we want to measure if patients have improved function or reduced pain? Do we want to measure whether our patients overall health has improved? What are the requirements of the payer-specific program for which we are hoping to qualify? O A L S
Select Measures that support Goals Let your goals direct your team to the instrument(s) that support your goals and objectives Key Considerations Are we concerned with quality of life measures or function? Are licensing costs to use an instrument a barrier? What is the associated patient burden? (Length/Complexity of Instrument) What is the associated staff burden to administer and collect data? For Example If your institution has decided to collect PROMs for research initiatives, consider an instrument that measures multiple domains -However- If your goals are focused on measuring patients outcomes as part of your clinical care, as shorter instrument may suffice provided the instrument can detect and measure change
Define Frequency of Data Collection PROMs guidelines from the International Consortium for Health Outcome Measurement (ICHOM) recommends a pre-op baseline and a one-year follow-up For instruments administered via the Registry platform, institutions may choose an option for subsequent yearly follow-ups Annual Yrly POST-OP National Benchmarks Provided; 1 Year post procedure CJR Final Rule advises survey completion within 270-365 days post surgery National Benchmarks Provided; Survey completion within 90 days of procedure PRE-OP 3 Mo. 6 Mo. 9 Mo. For instruments administered via the Registry platform, additional interval options are available for institutions that choose higher frequency intervals for research or other identified purposes
Define Data Collection Workflow Consider the following when designing the workflow that will best support your institution s existing processes, systems and resources What are the planned patient encounters (pre and post op)? Will your patients respond better to electronic or paper? Do surgeons need access to the patient responses during the encounter? Should surveys be administered at the clinic or be completed at home by the patient? Do you have the staff resources required to support the desired workflow? Are staff responsibilities clearly defined?
Patient Reported Outcome Measures: Collection to Action Workflow for Electronic-Based Survey Administration Step 1: PATIENT Completes Survey Step 2: STAFF PERSON Completes Data Entry Step 4: DATA TRANSMITTED to Registry Step 5: Data ACCESSED for Institution s Defined Usage Scenarios Method(s): Method(s): Method(s): Use Case(s): Patient Completes Survey at Pre or Post Op Office Visit via Tablet or Laptop via the Registry Platform Data Stored Securely in Registry Platform Patient Discussions; Shared Decision Making Clinic/Hospital Calls Patient and Records Responses in the Registry Platform Data Stored Securely in Registry Platform Institutional Quality Initiatives Institutional Research Initiatives Survey Link is Emailed to Patient to complete in the Registry Platform (Device Compatible) Data Stored Securely in Registry Platform Federal Initiative Reporting (i.e. CJR) Survey is completed electronically via the Institution s EHR or Other Survey Platform Data uploaded for Registry submission (Level III File Specifications) Pain Management Referrals; Post Operative Complication Assessment Input
Patient Reported Outcome Measures: Collection to Action Workflow for Paper-Based Survey Administration Step 1: PATIENT Completes Survey Step 2: STAFF PERSON Completes Data Entry Step 4: DATA TRANSMITTED to Registry Step 5: Data ACCESSED for Institution s Defined Usage Scenarios Method(s): Method(s): Method(s): Use Case(s): Patient Completes Paper Survey at Pre or Post Op Office Visit Staff Enters into AJRR Platform Patient Discussions; Shared Decision Making Data Stored Securely in Registry Platform Institutional Quality Initiatives Clinic/Hospital Calls Patient and Records Responses on Paper Form Staff Enters into Institution s EHR system Data uploaded for Registry submission (Level III File Specifications) Institutional Research Initiatives Federal Initiative Reporting (i.e. CJR) Clinic/Hospital Mails Survey; Patient Mails Back Paper Based Responses to Clinic/Hospital Staff Enters into Excel File Pain Management Referrals; Post Operative Complication Assessment Input
PART 1: REGISTRY PLATFORM OVERVIEW System Roles Overview Platform Solution Overview Platform Features/Functions Overview
What is the Registry System Platform?
Data Access Options The Registry System platform offers 2 primary access points for viewing data submitted and uploaded to the Registry: 1 Data 2 Mart National Dashboards Pre-defined PATIENT/CASE level data Exportable to Excel for additional analysis Pre-defined AGGREGATE level data Filters available for benchmark analysis
Registry Platform Site Structure (Features & Functions Summary)
Q&A
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