National Joint Registry for England and Wales 2nd Annual Report | September 2005 …realising the potential National Joint Registry for England and Wales 2nd Annual Report | September 2005 Prepared by The National Joint Registry (NJR) Centre Peoplebuilding 2 The Royal College of Surgeons Peoplebuilding Estate Clinical Effectiveness Unit Maylands Avenue Jan van der Meulen Hemel Hempstead HP2 4NW James Lewsey England Sarah Hardoon Website: www.njrcentre.org.uk & Helpline: 0845 345 9991 The NJR Centre, Harwell Fax: 0845 345 9992 Fiona Davies, Martin Pickford, Holly Firmin, Leigh Email: [email protected] Mapledoram, Claire Newell, Sandra Hasler, Ian Calcutt, Lee Sims, with support from the rest of the ISSN 1745-1442 NJR Centre team & The NJR Editorial Board for the 2nd Annual Report Paul Gregg Martyn Porter Tim Wilton Colin Thomson Andy Crosbie Mick Borroff John Timperley Peter Howard Mark Noterman Jan van der Meulen Fiona Davies National Joint Registry for England and Wales 2nd Annual Report | September 2005 …realising the potential Foreword As Chairman of the NJR Steering Committee, it much appreciated. This project has been carried is my pleasure to present the 2nd Annual Report through with enthusiasm and dedication by AEA covering the calendar year 2004. This is a year Technology plc and I record my thanks to them. that has seen a significant increase in the Bill Darling submission of completed records. During the Chair, NJR Steering Committee 2004 data collection period1, a total of 93,885 submissions were received, an average of 7,824 procedures per month compared to an average It gives me great pleasure to join Bill Darling, of 5,200 per month for the 2003 data collection again, in presenting the 2nd Annual Report of period. By December 2004, 381 centres were the NJR. participating in data collection, an increase of 41 centres over the previous year. Significant progress has been made since publication of the 1st Annual Report. Almost all Bringing the statistics as up to date as possible, hospitals in England and Wales, both in the NHS on 24 June 2005 the 200,000th record was and independent sector, have submitted data to entered into the NJR system and by the end of the NJR. There are now 2,4002 new records July a total of 212,107 records had been entered each week. entered, highly gratifying figures. The average consent rate for that month was 72.9%, and Other significant developments during the year 98.8% of all hospitals on the NJR database had include the introduction of Minimum Dataset submitted data by the end of July 2005. version 2 (MDS v2), development of the bulk upload facility, and an agreement to provide However, much remains to be done if the data each hospital on request with a bar code reader we have collected are to realise their full to facilitate the entry of implant data via the new potential in improving orthopaedic care. In bar code reader facility. particular, we need to increase patient consent and the collection of NHS numbers for This year has seen significant input from the consented patients. This must be our main NJR to the work of the Orthopaedic Data objective for 2005 and a number of measures Evaluation Panel (ODEP) in providing a are under active consideration to enable us to comprehensive view of hips available on the UK do this urgently. market and their compliance with NICE benchmarks. I again record my thanks to my Vice Chair, Professor Paul Gregg who has been tireless in The expansion of the Regional Audit Co-ordinator his efforts to take the project forward. I also pay team from 5 to 7 RACs has allowed increased tribute to the work of the Regional Clinical Co- communication between the NJR Centre and ordinators who continue to give of their time individual hospitals. The RACs will have a key unstintingly. Their advice and support is very role to play, in the future, in achieving complete 1 The 2004 data collection period relates to hip and knee replacement procedures that took place between 1 January and 31 December 2004 inclusive and that were entered onto the NJR database by 28 February 2005. These data were then used in analyses for the 2nd Annual Report The 2003 data collection period relates to hip and knee replacement procedures that took place between 1 April and 31 December 2003 inclusive and that were entered onto the NJR database by 31 March 2004. These data were then used in analyses for the 1st Annual Report (Data for both 2003 and 2004 have continued to be entered onto the NJR database beyond these end dates, although they could not contribute to the 1st and 2nd Annual Report analyses respectively.) 2 This weekly submission rate is the average rate over the previous four weeks. The figure given is for July 2005 1 National Joint Registry for England and Wales 2nd Annual Report September 2005 registration of all hip and knee replacements, in I would like to add my sincere thanks to those of rolling out the NJR Data Integrity Audit process Bill Darling for all the hard work and support of across all units and, in particular, in improving the the many people who have been involved in this NJR patient consent rates recorded. very ambitious project. In particular, I would like to thank Bill, in his role as Chair of the NJR This report also includes the results from the first Steering Committee, for his on-going support Patient Reported Outcome Measurement and the very fair and transparent way in which Studies (PROMS) survey, which was carried out he continues to conduct the functioning of the in a group of 20,000 patients who had Steering Committee. Surgeon involvement, previously undergone replacement of a hip or outwith the main Steering Committee, is knee joint. This postal survey achieved an facilitated in a number of ways, but particularly excellent response rate of 88% that, presumably, via the Regional Clinical Co-ordinators. This indicates the importance that patients attach to continues to bring positive results. this initiative. A second, and much more detailed, longitudinal study is planned for 2006, I maintain my belief that the NJR will be good for with a pilot starting in August 2005. patients and we must remain conscious of the surgeons’ responsibility to be accountable to The application of the NJR levy3 continues to them. They have every right to expect openness work extremely well and has provided a sound with regard to professional performance. I hope financial basis for the running and further that the continued and increased participation in development of the NJR. the NJR will send a clear signal of the Despite the significant progress during the past orthopaedic surgical profession’s commitment year, much still needs to be done in the future. In to this. particular, there remain a number of hospitals Paul Gregg which only enter a small percentage of the hip Vice Chair, NJR Steering Committee and knee replacements they perform and consent rates remain disappointingly low. Unless this can be significantly improved upon in the future, it will not be possible to achieve some of the main aims of the NJR. 3 The costs associated with ongoing operation and development of the NJR are funded through a levy placed on the sale of specific total hip and total knee prostheses 2 Executive Summary Introduction Highlighting developments This is the 2nd Annual Report of the National The intense activity of the set-up period of the Joint Registry (NJR) for England and Wales. The NJR has continued, but spread across a NJR collects information on total hip and knee broader range of areas. replacements carried out in both the NHS and ❚ As development of the NJR has progressed, independent sectors. a structure of advisory groups and sub committees has evolved to support the work Report structure of the Steering Committee. These are the: – NJR Outlier Performance Advisory Group The report is structured in three parts for ease of (NOPAG) use: – NJR Research Sub Committee (NJR RSC) ❚ Part 1 reports on key activities that took place between 1 January 2004 and 31 July 2005 that – Patient Reported Outcomes Measurement were not included in the 1st Annual Report Studies (PROMS) group. Part 1, s3.5 ❚ Part 2 focuses on data analysis and ❚ Further development of the Minimum Dataset interpretation. Data available for analysis was carried out to enhance future data covers 21 months and has allowed a wider analysis and subsequent interpretation to range of analyses to be carried out. improve patient outcomes. MDS v2 also aims Reflecting developments in technologies and to provide a more objective measure of techniques, analyses examine, for example, epidemiological case mix and complexity. the prevalence of hip resurfacing and use of Overall, MDS v2 provides a more minimally invasive surgery. Although early comprehensive dataset yet requires fewer but findings must be regarded as preliminary, their more targeted fields to be completed. In possible implications are of interest parallel, the data entry system has evolved to become more user friendly and make data ❚ Part 3 of the report provides appendices to entry easier. Part 1, s7.1 support both Part 1 text and Part 2 analyses. The web version of the report also includes ❚ As a consequence of listening to early additional appendices to support both Parts feedback, major developments initiated in 1 and 2 2004 included the development of a bar code reader facility and a bulk data upload facility. Also, the number of surgeon default techniques available has been expanded. All of these developments reduce both time needed for data entry and the likelihood of errors.