17 September 2009: National Joint Registry's 6th Annual Report publishes
More health professionals than ever before are turning to the National Joint Registry (NJR) for data that will help them to improve patient care, as well as inform their studies and research. This is because not only is the NJR the largest such registry in the world, but it is now an effective clinical audit of the quality of joint replacement treatment.
According to the NJR's 6th Annual Report, a record amount of data on hip and knee joint replacement procedures has been requested by orthopaedic surgeons, suppliers and manufacturers of joint replacement implants and patients. This dramatic rise in data requests clearly demonstrates the importance to health professionals and patients of the information held on the Register for the purpose of quality monitoring and improvement.
Further improving the accessibility and value of the data has been a priority for NJR this year with the launch in November 2008 of NJR Clinician Feedback. A secure online service, it enables surgeons to assess their clinical practice and compare it to that of their colleagues at hospital, regional (strategic health authority), sector (NHS or independent) and national levels; and through this, to identify practice that could be improved.
A total of 160,027 hip and knee joint replacement operations were reported to the NJR during the year under review, which represents 92.5% of all such operations carried out in England and Wales in the NHS and independent healthcare sectors.
This success is underpinned by rising rates of patient consent and linkability. During 2008/09, 87.5% of records submitted included consent from patients for their personal information to be held on the Register, the highest annual rate to date. This means that of all records held by the NJR, 78% now have patient consent. The NJR also saw record numbers of submissions with an NHS number.
Among other trends identified in the Report is the reduction in the average age of patients undergoing primary hip replacement surgery from 68.1 years in 2004 to 66.7 years.
During the same period, the average body mass index (BMI) of patients having hip replacement surgery rose from 27.8 to 28.3. The average BMI of knee replacement patients has also risen in the last five years from 29.7 to 30.3. This is equivalent to a weight gain of 1.85kg (four pounds) for a person of average height and means that the average knee replacement patient, by BMI measurement, is now clinically obese.
Bill Darling, Chair of the NJR Steering Committee, said he was in no doubt that the NJR, the largest Register of its kind in the world, was a tool of excellence that was supporting improvements in practice and patient care.
He commented: "The quality of the data held on the Register is such that we can now quickly inform hospitals of potential problems with implants and so greatly reduce the time between identification of an issue and a patient review.
"For the first time this year, an implant was withdrawn from sale by its supplier using information provided by the Register's outlier analysis following a device alert issued by the Medicines and Healthcare products Regulatory Agency (MHRA).
"The NJR was able quickly to identify patients who had received the implant and inform the relevant hospitals. Our ability to track patients is greatly enhanced by staff in hospitals and units obtaining patient consent, which, I am pleased to report, is happening on an increasingly frequent basis", he added.
Mr Darling went on to say that the overall rate of compliance of hospitals and treatment centres submitting data to the NJR had shown a steady upward trend since 2004, although a slight drop was reported in 2008/09.
Looking ahead, Mr Darling said that a significant development for NJR would be its participation in the national Patient Reported Outcome Measures (PROMs) study, commissioned by the Department of Health (DH).
"Agreement has been reached with the DH for PROMs data to be linked with the NJR data, enabling the Registry to provide outcomes information for the first time from the perspective of patients rather than clinicians," he explained.
Robin Burgess, the Chief Executive of the Healthcare Quality Improvement Partnership (HQIP), which manages the Registry, said: "This new report highlights that the Registry provides a significant measure of effective practice in joint replacement. Since HQIP took over the oversight of the Registry in April 2008 we have been examining how the Registry can develop further to offer a higher level of audit functions. A new strategic plan for the development of the Registry will carry through the work reported here in subsequent years."
Professor Alex MacGregor, a member of the NJR Steering Committee, added: "This study demonstrates the power of the NJR. It will be the first time that technical data on surgery is linked to directly to the patient's experience of surgery on a national scale. The information will be invaluable to both surgeons and their prospective patients."
Plans for further developments to the NJR include extending it to data relating to ankle, shoulder, elbow and wrist joint replacement surgery.
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