Internal quality register for joint prostheses

Collection and processing of data

In 2008, seven health registries were given the status of national quality registries, including the National Registry of Joint Prostheses. At the same time, Hemit was commissioned to develop a nationwide solution for electronic registration on behalf of all the registries. Since this work was thought to require some time, we were recommended to establish a temporary data base. We use paper-based forms that follow the patient through the entire treatment sequence and are finally scanned and machine-read.

The entire professional community has been involved in the selection of clinical and process-related variables. The collection of data is partly based on self-reporting by patients and partly on registration by physiotherapists and nurses (Figure 1). Specific forms used for the joint affliction in question, such as the Harris Hip Score, the Knee Society Score, the Hip Dysfunction and Osteoarthritis Outcome Score-Physical Function Short Form (HOOS-PS) and the Knee Injury and Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS), a prosthetic-specific form (National Joint Prostheses Registry) and a health questionnaire (EQ-5D) are all completed. Patients are also requested to fill in an anonymous form on patient satisfaction. The patient registration form contains five parts. The first part is completed in the context of a clinical consultation with an orthopaedist. The patients are handed out a form to report satisfaction, which will be used to provide a continuous assessment during the entire treatment sequence. Then a physiotherapist undertakes a function test of the afflicted joint. The second stage, describing anaesthetics and the surgical procedure, is completed perioperatively by the nurse anaesthetist in the department of surgery. The third part, describing the duration of anaesthetics, pain, nausea and mobilisation, is completed by the intensive-care nurse in the intensive-care unit. The fourth part is completed by the nurse on the ward, and includes information on pain, use of analgesics and mobilisation. The fifth stage is completed by the ward nurse at discharge, and includes registration of complications, if any, during the hospitalisation.

The patients should be followed up by a physiotherapist after eight weeks (for a knee prosthetic) or three months (for a hip prosthetic), and subsequently after one year and seven years. The same scoring forms are completed again. Information on professional status, any new complications and patient satisfaction is registered. All the paper-based forms are scanned into the data base. Selected registry data are reported to the project group on a monthly basis and to the management group every quarter.