ICOR-USA Collaboration

The International Consortium of Orthopedic Registries' USA Collaboration (ICOR-USA) aims to develop a US national device surveillance network in the orthopedic device space. ICOR-USA is a collaborative effort between the FDA's MDEpiNet-Weill Cornell Medicine Science and Infrastructure Center, and orthopedic registries such as the American Joint Replacement Registry, Kaiser Permanente's Total Joint Replacement Registry, the FORCE-TJR project, and HealthEast.

The FDA's new post-market surveillance vision highlights the importance of national registries and linkages with detailed datasets such as billing or administrative claims data and other routinely collected electronic data for the creation of a national system for post-market surveillance. Total joint replacement is the fastest growing elective device based surgery in the nation, if not in the world, with over 1.2 million hip and knee replacements performed annually in the U.S. With the aging of the baby boomer generation, higher rates of osteoarthritis diagnoses, innovative treatment options, and the growing demand for improved mobility and quality of life, procedure volumes are projected to reach 3 million annually in the next two decades. The performance of thousands of hip and knee devices is the most critical device safety issue in the U.S. today.

Major evidence gaps in device performance exist and, through this project, we will capitalize on a novel partnership within the FDA's Medical Device Epidemiology Network (MDEpiNet) to build a national infrastructure and fill the gaps in evidence. Our initiative aims to bring together registries in a systematic way and obtain longer, more complete patient follow-up via data linkages. Our network will be a resource to address the safety and effectiveness of new devices as they enter routine usage. Using this data network, researchers will be able to conduct comparative effectiveness studies within a short period after their market entry. Linkages between registries and state/national claims datasets will also significantly benefit registry efforts, including validation of complications, increased follow-up rate, ability for risk adjustment, and increased information about patient characteristics. This in turn will allow the registries to better serve their contributing hospitals by providing more detailed, useful reports. 

By harmonizing and linking clinical registry information from diverse registries in the orthopedic setting, we aim to share knowledge about best practices for data collection, linkages with claims and other data systems, analytics, and dissemination. Moreover, the collaboration and demonstration of the value of registries will strengthen support from stakeholders. The consortium can serve as a basis for fulfillment of pre- and post-approval requirements related to orthopedic devices.

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Collaborators

Kaiser Permanente

Kaiser Permanente (KP) is a partner within the MDEpiNet Science & Infrastructure Center, and boasts several inter-regional implant registries that capture patient demographics, implant characteristics, surgical techniques, and outcomes, including a variety of orthopaedic devices/surgeries such as total knee/hip, anterior cruciate ligament (ACL), spine, shoulder, and hip fracture. The device registries were developed to address recall situations, disseminate best practices, identify patients at risk for failure and assess clinical effectiveness of total joint replacement implants. In addition to the inter-regional implant registries, KP also has the world's largest private sector EHRs, KP HealthConnect┬«. Interconnection of all patient encounters within the EHR allows extraction of laboratory, procedural, diagnostic, pharmacy, and hospital encounters for all members in every patient care setting across KP's regions. These data supplement inter-regional implant registries and provide a foundation for longitudinal assessment of medical devices. 

American Joint Replacement Registry

The American Joint Replacement Registry (AJRR) is the national clinical data registry for total joint replacement that was certified by the Centers for Medicare & Medicaid Services (CMS) as a Qualified Clinical Data Registry in 2014. Founded in 2009 as a supporting organization of the American Academy of Orthopaedic Surgeons (AAOS), AJRR became an independent not-for-profit 501(c)3 organization in January 2015. AJRR is a multi-stakeholder initiative and also owns and manages the California Joint Replacement Registry (CJRR). As of November 2016, AJRR enrolled 826 hospitals from all 50 states and the District of Columbia nearly 600,000 procedures have been submitted to AJRR, with the most recent year of data submissions corresponding to approximately 18% of the annual procedural volume in the U.S. AJRR's procedural dataset includes information from other large institutional registries, such as the HealthEast Joint Replacement Registry and  the Connecticut Joint Replacement Institute.. It includes as participants 20 of the top 25 orthopaedic hospitals, as ranked by US News and World Report.

Weill Cornell Medicine

The Department of Healthcare Policy and Research at Weill Cornell Medicine (WCM) is home to MDEpiNet's Science and Infrastructure Center. It was previously a home to Agency for Healthcare Research and Quality (AHRQ)-funded Center for Education and Research on Therapeutics (CERT) focused on medical devices. WCMC and the partners in this effort provide a robust platform for large-scale research and surveillance efforts. Dr. Sedrakyan, the principal investigator, has extensive experience in medical device research and supervision. He worked at AHRQ and FDA, and supervised many large grants and contracts including the CERT program. He is the lead for the MDEpiNet Science and Infrastructure Center and patient-centered comparative research team at WCM.

Medical Device Epidemiology Network (MDEpiNet)

MDEpiNet Public Private Partnership is a voluntary organization within the FDA's Center for Devices and Radiological Health (CDRH) which is working to build a national medical device evaluation system bybringing together leadership, expertise, and resources to build and operate a national device ecosystem supporting the development, regulation, and use of innovative medical devices. The MDEpiNet initiative was launched under the leadership of Dr. Danica Marinac-Dabic, who serves as the Director of the Division of Epidemiology within the CDRH. Dr. Marinac-Dabic has years of experience in medical device regulatory science, particularly in the area of safety and effectiveness in the post-market setting.

FORCE-TJR

The Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) registry is created and managed by University of Massachusetts Medical School's Department of Orthopaedics. To date, FORCE-TJR has collected and analyzed comprehensive post-TJR data on more than 30,000 patients treated by a diverse and nationally representative group of surgeons, and hospitals in 24 states. Urban and rural environments, academic and community hospitals, and low and high volume practices are represented. Patient enrollment is ongoing and will exceed 35,000 in 2015. Uniquely, patients consent to (a) complete annual patient-reported outcomes (pain and function) and (b) report adverse events and surgical revisions at intervals for years into the future. A secure web-based data collection platform is used for direct data submission from patients and clinicians. Longitudinal data is complete with at least 85% follow-up for patient-reported outcomes. Data from patients and clinicians is supplemented with data from a variety of other sources including administrative claims, implant data, and x-rays.

HealthEast

The HealthEast Joint Replacement Registry (HJRR) began in 1991 and was the first community-based registry of its kind in the US. The HJRR has been influential in the development of the national system for orthopedic device study, and has been performing critical research studies and publishing their findings in the field for decades. The HJRR was one of the first participating sites during the development of the AJRR, and remains a charter member of the AJRR organization. They have been participating in ICOR since its inception in 2011.

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Publications

Cafri G, Banerjee S,  Sedrakyan A, Paxton L, Furnes O, Graves S, Marinac-Dabic D. Meta-analysis of survival curve data using distributed health data networks: application to hip arthroplasty studies of the International Consortium of Orthopaedic Registries. Res Synth Methods. 2015 Dec;6(4):347-56. doi: 10.1002/jrsm.1159. PubMed

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