Heather A. Prentice PhD (is Epidemiologist, Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego.), Jessica E. Harris MS (is Senior Manager, Clinical Consulting Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego.), Kenneth Sucher MS (is Manager, Administrative Team, Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego.), Brian H. Fasig PhD (is Managerial Senior Consultant, Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego.), Ronald A. Navarro MD (is Professor and Director of Clinical Affairs, Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Harbor City, California.), Kanu M. Okike MD (is Orthopaedic Surgeon, Department of Orthopaedic Surgery, Hawaii Permanente Medical Group, Honolulu.), Gregory B. Maletis MD (is Chief, Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Baldwin Park, California.), Kern H. Guppy MD, PhD (is Director, Neurosurgery Spine Program, Department of Neurosurgery, Permanente Medical Group, Sacramento, California.), Robert W. Chang MD (is Assistant Chair, Department of Vascular Surgery, Permanente Medical Group, South San Francisco, California, and Adjunct Investigator, Division of Research, Kaiser Permanente Northern California, Oakland.), Matthew P. Kelly MD (is Orthopaedic Surgeon, Southern California Permanente Medical Group, Harbor City, California.), Adrian D. Hinman MD (is Orthopaedic Surgeon Department of Orthopaedic Surgery, Permanente Medical Group, San Leandro, California.), Elizabeth W. Paxton PhD (is Director, Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego. Please address correspondence to Heather A. Prentice)
{"title":"在医疗系统内使用植入物登记册可提高质量、安全性和成本","authors":"Heather A. Prentice PhD (is Epidemiologist, Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego.), Jessica E. Harris MS (is Senior Manager, Clinical Consulting Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego.), Kenneth Sucher MS (is Manager, Administrative Team, Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego.), Brian H. Fasig PhD (is Managerial Senior Consultant, Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego.), Ronald A. Navarro MD (is Professor and Director of Clinical Affairs, Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Harbor City, California.), Kanu M. Okike MD (is Orthopaedic Surgeon, Department of Orthopaedic Surgery, Hawaii Permanente Medical Group, Honolulu.), Gregory B. Maletis MD (is Chief, Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Baldwin Park, California.), Kern H. Guppy MD, PhD (is Director, Neurosurgery Spine Program, Department of Neurosurgery, Permanente Medical Group, Sacramento, California.), Robert W. Chang MD (is Assistant Chair, Department of Vascular Surgery, Permanente Medical Group, South San Francisco, California, and Adjunct Investigator, Division of Research, Kaiser Permanente Northern California, Oakland.), Matthew P. Kelly MD (is Orthopaedic Surgeon, Southern California Permanente Medical Group, Harbor City, California.), Adrian D. Hinman MD (is Orthopaedic Surgeon Department of Orthopaedic Surgery, Permanente Medical Group, San Leandro, California.), Elizabeth W. Paxton PhD (is Director, Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego. Please address correspondence to Heather A. Prentice)","doi":"10.1016/j.jcjq.2024.01.011","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Clinical quality registries (CQRs) are intended to enhance quality, safety, and cost reduction using real-world data for a self-improving health system. Starting in 2001, Kaiser Permanente established several medical device CQRs as a quality improvement initiative. This report examines the contributions of these CQRs on improvement in health outcomes, changes in clinical practice, and cost-effectiveness over the past 20 years.</p></div><div><h3>Methods</h3><p>Eight implant registries were instituted with standardized collection from the electronic health record and other institutional data sources of patient characteristics, medical comorbidities, implant attributes, procedure details, surgical techniques, and outcomes (including complications, revisions, reoperations, hospital readmissions, and other utilization measures). A rigorous quality control system is in place to improve and maintain the quality of data. Data from the Implant Registries form the basis for multiple quality improvement and patient safety initiatives to minimize variation in care, promote clinical best practices, facilitate recalls, perform benchmarking, identify patients at risk, and construct reports about individual surgeons.</p></div><div><h3>Results</h3><p>Following the inception of the Implant Registries, there was an observed (1) reduction in opioid utilization following orthopedic procedures, (2) reduction in use of bone morphogenic protein during lumbar fusion allowing for cost savings, (3) reduction in allograft for anterior cruciate ligament reconstruction and subsequent decrease in organizationwide revision rates, (4) cost savings through expansion of same-day discharge programs for joint arthroplasty, (5) increase in the use of cement fixation in the hemiarthroplasty treatment of hip fracture, and (6) organizationwide discontinuation of an endograft device associated with a higher risk for adverse outcomes following endovascular aortic aneurysm repair.</p></div><div><h3>Conclusion</h3><p>The use of Implant Registries within our health system, along with clinical leadership and organizational commitment to a learning health system, was associated with improved quality and safety outcomes and reduced costs. The exact mechanisms by which such registries affect health outcomes and costs require further study.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 6","pages":"Pages 404-415"},"PeriodicalIF":2.3000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Improvements in Quality, Safety and Costs Associated with Use of Implant Registries Within a Health System\",\"authors\":\"Heather A. Prentice PhD (is Epidemiologist, Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego.), Jessica E. Harris MS (is Senior Manager, Clinical Consulting Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego.), Kenneth Sucher MS (is Manager, Administrative Team, Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego.), Brian H. Fasig PhD (is Managerial Senior Consultant, Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego.), Ronald A. Navarro MD (is Professor and Director of Clinical Affairs, Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Harbor City, California.), Kanu M. Okike MD (is Orthopaedic Surgeon, Department of Orthopaedic Surgery, Hawaii Permanente Medical Group, Honolulu.), Gregory B. Maletis MD (is Chief, Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Baldwin Park, California.), Kern H. Guppy MD, PhD (is Director, Neurosurgery Spine Program, Department of Neurosurgery, Permanente Medical Group, Sacramento, California.), Robert W. Chang MD (is Assistant Chair, Department of Vascular Surgery, Permanente Medical Group, South San Francisco, California, and Adjunct Investigator, Division of Research, Kaiser Permanente Northern California, Oakland.), Matthew P. Kelly MD (is Orthopaedic Surgeon, Southern California Permanente Medical Group, Harbor City, California.), Adrian D. Hinman MD (is Orthopaedic Surgeon Department of Orthopaedic Surgery, Permanente Medical Group, San Leandro, California.), Elizabeth W. Paxton PhD (is Director, Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego. Please address correspondence to Heather A. Prentice)\",\"doi\":\"10.1016/j.jcjq.2024.01.011\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Clinical quality registries (CQRs) are intended to enhance quality, safety, and cost reduction using real-world data for a self-improving health system. Starting in 2001, Kaiser Permanente established several medical device CQRs as a quality improvement initiative. This report examines the contributions of these CQRs on improvement in health outcomes, changes in clinical practice, and cost-effectiveness over the past 20 years.</p></div><div><h3>Methods</h3><p>Eight implant registries were instituted with standardized collection from the electronic health record and other institutional data sources of patient characteristics, medical comorbidities, implant attributes, procedure details, surgical techniques, and outcomes (including complications, revisions, reoperations, hospital readmissions, and other utilization measures). A rigorous quality control system is in place to improve and maintain the quality of data. Data from the Implant Registries form the basis for multiple quality improvement and patient safety initiatives to minimize variation in care, promote clinical best practices, facilitate recalls, perform benchmarking, identify patients at risk, and construct reports about individual surgeons.</p></div><div><h3>Results</h3><p>Following the inception of the Implant Registries, there was an observed (1) reduction in opioid utilization following orthopedic procedures, (2) reduction in use of bone morphogenic protein during lumbar fusion allowing for cost savings, (3) reduction in allograft for anterior cruciate ligament reconstruction and subsequent decrease in organizationwide revision rates, (4) cost savings through expansion of same-day discharge programs for joint arthroplasty, (5) increase in the use of cement fixation in the hemiarthroplasty treatment of hip fracture, and (6) organizationwide discontinuation of an endograft device associated with a higher risk for adverse outcomes following endovascular aortic aneurysm repair.</p></div><div><h3>Conclusion</h3><p>The use of Implant Registries within our health system, along with clinical leadership and organizational commitment to a learning health system, was associated with improved quality and safety outcomes and reduced costs. The exact mechanisms by which such registries affect health outcomes and costs require further study.</p></div>\",\"PeriodicalId\":14835,\"journal\":{\"name\":\"Joint Commission journal on quality and patient safety\",\"volume\":\"50 6\",\"pages\":\"Pages 404-415\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Joint Commission journal on quality and patient safety\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1553725024000400\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Joint Commission journal on quality and patient safety","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1553725024000400","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
Improvements in Quality, Safety and Costs Associated with Use of Implant Registries Within a Health System
Background
Clinical quality registries (CQRs) are intended to enhance quality, safety, and cost reduction using real-world data for a self-improving health system. Starting in 2001, Kaiser Permanente established several medical device CQRs as a quality improvement initiative. This report examines the contributions of these CQRs on improvement in health outcomes, changes in clinical practice, and cost-effectiveness over the past 20 years.
Methods
Eight implant registries were instituted with standardized collection from the electronic health record and other institutional data sources of patient characteristics, medical comorbidities, implant attributes, procedure details, surgical techniques, and outcomes (including complications, revisions, reoperations, hospital readmissions, and other utilization measures). A rigorous quality control system is in place to improve and maintain the quality of data. Data from the Implant Registries form the basis for multiple quality improvement and patient safety initiatives to minimize variation in care, promote clinical best practices, facilitate recalls, perform benchmarking, identify patients at risk, and construct reports about individual surgeons.
Results
Following the inception of the Implant Registries, there was an observed (1) reduction in opioid utilization following orthopedic procedures, (2) reduction in use of bone morphogenic protein during lumbar fusion allowing for cost savings, (3) reduction in allograft for anterior cruciate ligament reconstruction and subsequent decrease in organizationwide revision rates, (4) cost savings through expansion of same-day discharge programs for joint arthroplasty, (5) increase in the use of cement fixation in the hemiarthroplasty treatment of hip fracture, and (6) organizationwide discontinuation of an endograft device associated with a higher risk for adverse outcomes following endovascular aortic aneurysm repair.
Conclusion
The use of Implant Registries within our health system, along with clinical leadership and organizational commitment to a learning health system, was associated with improved quality and safety outcomes and reduced costs. The exact mechanisms by which such registries affect health outcomes and costs require further study.
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