Percentage of patients 19 years of age and older who received an elective primary total hip arthroplasty (THA) and completed a functional status assessment within 90 days prior to the surgery and in the 270 - 365 days after the surgery

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Total hip arthroplasties (THAs) are common surgical procedures that address hip pain and functional impairment, primarily caused by osteoarthritis. Although THA is an effective procedure for addressing osteoarthritis for many patients, some people, particularly those with more severe preoperative pain and impairment, do not experience the improvements in pain, function, and quality of life expected from the procedure (Beswick et al., 2012; Fortin et al., 1999; Tilbury et al., 2016). In 2010, providers performed 326,100 THAs, with 95 percent of them in patients age 45 and older (Wolford, Palso, & Bercovitz, 2015). Although THAs were introduced as a procedure for older adults, the percentage of patients age 55 to 64 (29 percent) who had a THA in 2010 exceeded the percentage of patients age 75 and older (26 percent) who had a THA (Wolford, Palso, & Bercovitz, 2015). Kurtz et al. (2009) projected that patients younger than 65 would account for 52 percent of THAs by 2030. This growth in hip surgeries for patients younger than 65 is significant because these patients often require more expensive joint arthroplasties that will better withstand the wear caused by physical activity (Bozic et al., 2006).

This measure evaluates whether patients complete a patient-reported functional status assessment (FSA) before and after a THA. Measuring functional status for patients undergoing THA permits longitudinal assessment - from the patient's perspective - of the impact of surgical intervention on pain, physical function, as well as health-related quality of life (Rothrock, 2010).

While there is no clinical guideline recommending that clinicians assess patients who are undergoing total hip replacements using patient-reported outcomes of function and pain, several clinical specialty societies support the use of a general health questionnaire and a disease-specific questionnaire for these patients. In particular, they recommend the Veterans RAND 12-item health survey (VR-12) or the Patient-Reported Outcomes Measurement Information System [PROMIS]-10-Global as the general health questionnaire and the Hip Disability and Osteoarthritis Outcome Score [HOOS], Jr. as the disease-specific questionnaire (American Association of Orthopaedic Surgeons, the American Joint Replacement Registry, The Hip Society, The Knee Society, & the American Association of Hip and Knee Surgeons, 2015).

A higher score indicates better quality

Reference Type: CITATION

Reference Text: 'American Association of Orthopaedic Surgeons, The American Joint Replacement Registry, The Hip Society, The Knee Society, & the American Association of Hip and Knee Surgeons. (2015). Patient-reported outcomes summit for total joint arthroplasty report. Retrieved from http://www.aahks.org/wp-content/uploads/2018/08/comment-letter-pro-summit-09082015.pdf'

Reference Type: CITATION

Reference Text: 'Beswick, A. D., Wylde, V., Gooberman-Hill, R., et al. (2012). What Proportion of Patients Report Long-Term Pain after Total Hip or Knee Replacement for Osteoarthritis? A Systematic Review of Prospective Studies in Unselected Patients. British Medical Journal Open, 2(1), 1-12.'

Reference Type: CITATION

Reference Text: 'Bozic, K. J., Morsehed, S., Silverstein, M. D., et al. (2006). Use of Cost-Effectiveness Analysis to Evaluate New Technologies in Orthopaedics: The Case of Alternative Bearing Surfaces in Total Hip Arthroplasty. Journal of Bone and Joint Surgery, American Volume, 88(4), 706-714.'

Reference Type: CITATION

Reference Text: 'Fortin, P. R., Clarke, A. E., Joseph, L., et al. (1999). Outcomes of Total Hip and Knee Replacement Preoperative Functional Status Predicts Outcomes at Six Months After Surgery. American College of Rheumatology, 42(8), 1722-1728.'

Reference Type: CITATION

Reference Text: 'Kurtz, S. M., Lau, E., Ong, K., et al. (2009). Future Young Patient Demand for Primary and Revision Joint Arthroplasty: National projections from 2010 to 2030. Clinical Orthopaedics and Related Research, 467(10), 2606-2612.'

Reference Type: CITATION

Reference Text: 'Rothrock, N. E., Hays, R. D., Spritzer, K., et al. (2010). Relative to the General U.S. Population, Chronic Diseases are Associated with Poorer Health-Related Quality of Life as Measured by the Patient-Reported Outcomes Measurement Information System (PROMIS). Journal of Clinical Epidemiology, 63(11), 1195-1204.'

Reference Type: CITATION

Reference Text: 'Tilbury, C., Haanstra, T. M., Leichtenberg, C. S., et al. (2016). Unfulfilled Expectations after Total Hip and Knee Arthroplasty Surgery: There is a Need for Better Preoperative Patient Information and Education. Journal of Arthroplasty, 31(10), 2136-2145.'

Reference Type: CITATION

Reference Text: 'Wolford, M. L., Palso, K., & Bercovitz, A. (2015, February). Hospitalization for Total Hip Replacement Among Inpatients Aged 45 and Over: United States, 2000-2010. NCHS Data Brief No. 186. Hyattsville, MD: National Center for Health Statistics.'

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The same functional status assessment (FSA) instrument must be used for the initial and follow-up assessment.

This eCQM is a patient-based measure.

This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

TBD

Patients 19 years of age and older who had a primary total hip arthroplasty (THA) in the year prior to the measurement period and who had an outpatient encounter during the measurement period

Equals Initial Population

Exclude patients with two or more fractures indicating trauma in the 24 hours before or at the start of the total hip arthroplasty or patients with severe cognitive impairment that starts before or in any part of the measurement period.

Exclude patients who are in hospice care for any part of the measurement period.

Patients with patient-reported functional status assessment results (i.e., Veterans RAND 12-item health survey [VR-12], Patient-Reported Outcomes Measurement Information System [PROMIS]-10-Global Health, Hip Disability and Osteoarthritis Outcome Score [HOOS], HOOS Jr.) in the 90 days prior to or on the day of the primary THA procedure, and in the 270 - 365 days after the THA procedure

Not Applicable

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For every patient evaluated by this measure also identify payer, race, ethnicity and sex