We all know that, for decades, Canadian consumers and retailers have benefited from the efficient recording and tracking of product information, using standardized bar codes, and relating that to the customers who use the products. What you may not know is that CIHI is using a similar approach to help policy-makers and clinicians better understand which medical device products work best for which patients.
CIHI’s Canadian Joint Replacement Registry (CJRR), launched in 2000, is the only pan-Canadian medical device registry that links hip and knee implant device information with patient hospitalization records to improve the quality of care patients receive and the outcomes they experience. CIHI and Canada’s orthopedic surgeons work collaboratively to ensure the ongoing success of the CJRR, which could prove to be a model for how information on medical devices is collected and used in the future.
Improving the quality of care and patient outcomes
Last year, CIHI reported that patients with a specific type of metal-on-metal hip replacement (large-diameter) were 1.6 times more likely to require a repeat surgery within five years to replace the implant than patients who received the most common type of metal-on-plastic implant. The finding was based on analysis of eight years of CJRR data.
These findings matter because patients whose artificial hips need to be replaced sooner than expected after an original joint replacement surgery require a revision surgery and the overall experience affects their quality of life. As well, the cost of a revision is higher than that of an initial hip replacement surgery. These patients stay in hospital an average of 17% longer than those undergoing the initial replacement surgery, and procedure costs in the hospital for revision are typically about 45% more than for the initial surgery (not including doctor fees and rehabilitation costs).
Surgeons can use the information from CJRR to assist them as they make careful decisions about what implants will work best for each of their patients, taking into consideration patient age, sex, level of physical activity and other factors.
The CJRR evolution
Historically, participation in CJRR was voluntary for orthopedic surgeons, and for years coverage across Canada was below 50%. In other words, only about half of all hip and knee replacement procedures were captured in the registry. In 2012, recognizing that a simplified submission approach could result in enhanced pan-Canadian coverage, CIHI moved to a new Minimum Data Set for CJRR (CJRR MDS) standard recommended by the International Society of Arthroplasty Registries. This significantly reduced the number of data elements that were submitted, as well as the time required to complete the entry of each record.
Following the transition to the CJRR MDS, British Columbia and Ontario implemented mandatory CJRR reporting from all of their hospitals, and Manitoba changed its mandate to fully electronic reporting in 2013–2014. This has increased pan-Canadian coverage from 43% in 2011–2012 to nearly 74% in 2012–2013, and CIHI is optimistic that this percentage will continue to increase.
CIHI is also improving the quality and usability of the registry data by
- Moving from paper to exclusively electronic submissions in April 2013;
- Allowing implant information to be scanned from barcodes rather than manually entering the information; and
- Working with partners such as GS1 Canada to influence manufacturers to adopt international barcode standards for hip and knee implants and provide implant product information in a central repository.
“As more jurisdictions make CJRR reporting mandatory, the data will paint a fuller picture for the surgeons and health system decision-makers,” says Greg Webster, CIHI’s Director of Acute and Ambulatory Care Information Services. “Robust, accurate data will ultimately result in better care for patients, and the rate at which patients requiring earlier repeat surgery should decrease.”