Quality measurement in orthopaedics: the purchasers' view.
While all of medicine is under pressure to increase transparency and accountability, joint replacement subspecialists will face special scrutiny. Disclosures of questionable consulting fees, a demographic shift to younger patients, and uncertainty about the marginal benefits of product innovation in a time of great cost pressure invite a serious and progressive response from the profession. Current efforts to standardize measures by the National Quality Forum and PQRI will not address the concerns of purchasers, payors, or policy makers. Instead, they will ask the profession to document its commitment to appropriateness, stewardship of resources, coordination of care, and patient-centeredness. One mechanism for addressing these expectations is voluntary development of a uniform national registry for joint replacements that includes capture of preoperative appropriateness indicators, device monitoring information, revision rates, and structured postoperative patient followup. A national registry should support performance feedback and quality improvement activity, but it must also be designed to satisfy payor, purchaser, policymaker, and patient needs for information. Professional societies in orthopaedics should lead a collaborative process to develop metrics, infrastructure, and reporting formats that support continuous improvement and public accountability.
Lansky
David
D
Pacific Business Group on Health (PBGH), San Francisco, CA 94105, USA. dlansky@pbgh.org
Milstein
Arnold
A
D000368:Aged; D019643:Arthroplasty, Replacement / Q000191:economics / Q000941:ethics / Q000592:standards*; D016265:Conflict of Interest; D003257:Consumer Product Safety; D003362:Cost-Benefit Analysis; D017049:Employer Health Costs / Q000592:standards*; D005607:Fraud / Q000517:prevention & control; D018166:Health Care Reform; D006282:Health Personnel / Q000191:economics / Q000941:ethics / Q000592:standards*; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000592:standards*; D007349:Insurance, Health, Reimbursement / Q000191:economics / Q000592:standards; D007595:Joint Prosthesis; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000191:economics / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000592:standards; D028743:Professional Misconduct; D016730:Program Development; D011474:Prosthesis Design; D011639:Public Opinion; D019984:Quality Indicators, Health Care / Q000191:economics / Q000941:ethics / Q000592:standards*; D012042:Registries; D012086:Reoperation; D012941:Social Responsibility; D013673:Technology Assessment, Biomedical / Q000191:economics / Q000592:standards; D016896:Treatment Outcome; D014481:United States