Awareness of performance on outcomes after total hip and knee arthroplasty among Dutch orthopedic surgeons: how to improve feedback from arthroplasty registries

Abstract

Background and purpose — The Netherlands Registry
of Orthopedic Implants (LROI) uses audit and feedback
(A&F) as the strategy to improve performance outcomes
after total hip and knee arthroplasty (THA/TKA). Effectiveness
of A&F depends on awareness of below-average performance
to initiate improvement activities. We explored
the awareness of Dutch orthopedic surgeons regarding their
performance on outcomes after THA/TKA and factors associated
with this awareness.

Methods — An anonymous questionnaire was sent to all
445 eligible Dutch orthopedic surgeons performing THA/
TKA. To assess awareness on own surgeon-group performance,
they were asked whether their 1-year THA/TKA
revision rates over the past 2 years were below average (negative
outlier), average (non-outlier), above average (positive
outlier) in the funnel plot on the LROI dashboard, or did
not know. Associations were determined with (1) dashboard
login at least once a year (yes/no); (2) correct funnel-plot
interpretation (yes/no) and; (3) recall of their 1-year THA/
TKA revision rate (yes/no).

Results — 44% of respondents started the questionnaire,
158 THA and 156 TKA surgeons. 55% of THA surgeons and
55% of TKA surgeons were aware of their performance. Surgeons
aware of their performance more often logged in on the
LROI dashboard, more often interpreted funnel plots correctly,
and more often recalled their revision rate. 38% of THA and
26% of TKA surgeons scored “good” on all 3 outcomes.

Interpretation — Only half of the orthopedic surgeons
were aware of their performance status regarding outcomes
after THA/TKA. This suggests that to increase awareness,
orthopedic surgeons need to be actively motivated to look at
the dashboard more frequently and educated on interpretation
of funnel plots for audit and feedback to be effective.