Registries Help Hospitals Keep Tabs on Patients with Joint Replacements

Hospitals & Health Networks—January 1, 2009

With no national system, hospitals must follow patients to see how they are doing.

The United States lacks a national system for tracking patients with artificial hips and knees. Absent such a database, a handful of hospitals are tackling the problem among their own patients.

For the past year, Hospital for Special Surgery in New York has been implementing its own registry, with the help of a grant from the National Institutes of Health.

HSS' registry takes a personalized approach, one requiring five full-time and one half-time research assistants along with a full-time senior coordinator. Registry staff members initially interview patients one on one when they can catch them—in the presurgery education class, during pre-op blood work, or at the presurgery meeting with the internist.

"If all else fails, we meet with them right before the operation," says Lisa Mandl, M.D., a rheumatologist at HSS and a co-director of the registry. "And if we've still missed them, we try to meet them the day after the surgery."

Sometimes, patients are too sick or too tired to participate, but between 85 percent and 90 percent agree to it.

Follow-up after six months—and then two and five years and ideally throughout the rest of the patient's life—has its own set of challenges. Mandl says she and her team are constantly tweaking the process. After the first set of six-month questionnaires went out, "we realized a lot of people have vacation homes, holiday places, and we clearly need those addresses along with their regular addresses," she says.

Mandl says the registry helps doctors factor lifestyle into the medical-device equation. "If you're a person who lives in Manhattan and you're this tall and you like to do this, what's the best device for you? We're really trying to find predictors for people doing well in the long haul. This takes time and effort and money. We want to find out what makes a patient happy. The surgeon says, 'Yes, everything works well,' but if the patient is miserable, that's not very good for the patient."