title: Implementation of patient-reported outcome measures in U.S. Total joint replacement registries: rationale, status, and plans.
abstract: BACKGROUND
  In the U.S. and abroad, the use of patient-reported outcome measures to evaluate the impact of total joint replacement surgery on patient quality of life is increasingly common. Analyses of patient-reported outcomes have documented substantial pain relief and functional gain among the vast majority of patients managed with total joint replacement. In addition, postoperative patient-reported outcomes are useful to identify persistent pain and suboptimal outcomes in the minority of patients who have them. The leaders of five U.S. total joint replacement registries report the rationale, current status, and vision for the use of patient-reported outcome measures in U.S. total joint replacement registries.
  
  
  METHODS
  Surgeon leaders of the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement registry, American Joint Replacement Registry, California Joint Replacement Registry, Michigan Arthroplasty Registry Collaborative Quality Initiative, and Virginia Joint Registry report the rationale supporting the adoption of patient-reported outcome measures, factors associated with the selection and successful implementation of patient-reported outcome measures, and barriers to complete and valid data.
  
  
  RESULTS
  U.S. registries are at varied stages of implementation of preoperative surveys and postoperative total joint replacement outcome measures. Surgeon leaders report unified rationales for adopting patient-reported outcome measures: to capture data on pain relief and functional gain following total joint replacement as well as to identify suboptimal implant performance. Key considerations in the selection of a patient-reported outcome measure include its ability to measure both joint pain and physical function while limiting any burden on patients and surgeons related to its use. Complete patient-reported outcomes data will be associated with varied modes of survey completion, including options for home-based completion, to ensure consistent timing and data capture.
  
  
  CONCLUSIONS
  The current stage of implementation of patient-reported outcome measures varies widely among U.S. registries. Nonetheless, evidence from the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement registry supports the feasibility of successful implementation of patient-reported outcome measures with careful attention to the selection of the outcome measure, mode and timing of postoperative administration, and minimization of any burden on the patient and surgeon.
authors.affiliation: Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655. E-mail address for P.D. Franklin: Patricia.Franklin@umassmed.edu.
authors.forename: Patricia D
authors.initials: PD
authors.lastname: Franklin
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., W4, Rochester, MN 55905.
authors.forename: David
authors.initials: D
authors.lastname: Lewallen
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco, 1500 Owens Street, San Francisco, CA 94158.
authors.forename: Kevin
authors.initials: K
authors.lastname: Bozic
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, 1500 East Medical Center Drive, Ann Arbor, MI 48109.
authors.forename: Brian
authors.initials: B
authors.lastname: Hallstrom
authors.affiliation: Department of Orthopaedic Surgery, Virginia Commonwealth University, 9000 Stony Point Parkway, Richmond, VA 23235.
authors.forename: William
authors.initials: W
authors.lastname: Jiranek
authors.affiliation: Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655. E-mail address for P.D. Franklin: Patricia.Franklin@umassmed.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Ayers
mesh_terms: D019643:Arthroplasty, Replacement; D006801:Humans; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction; D011788:Quality of Life; D012042:Registries; D016896:Treatment Outcome; D014481:United States