QualityPath™ Total Hip Replacement (THA) and Total Knee Replacement (TKA) Evaluation Criteria – DRAFT
QualityPath™ THA and TKA PHYSICIAN AND FACILTY EVALUATION CRITERIA
Criteria
Registry Participation Facility
Rationale
Facilities need timely, accurate and
clinically relevant information to
improve patient outcomes,
determine appropriate care, engage
patients in decision-making and be
good stewards of scarce resources.
Definition/Action
To be eligible for QualityPath™
designation, a facility must
participate in an external Joint
Replacement Registry that accepts
level 3 data (patient-reported
outcomes). Facility must submit
level 3 data to the registry.
Meets
Hospital registry results/report
provided to QualityPath™ to
confirm participation and
submission
Registry Participation Physician
Physicians need timely, accurate
and clinically relevant information
to improve patient outcomes,
determine appropriate care, engage
patients in decision-making and be
good stewards of scarce resources.
To be eligible for QualityPath™
designation, a physician must
participate in an external joint
replacement registry that accepts
level 3 data (patient-reported
outcomes). Physician must submit
level 3 data to the registry.
Physician results/report provided to
QualityPath™ to confirm
participation and submission
Transparency - Facility
Consumers have a right to know
about differences in cost and
quality between health care
facilities, physicians and other
clinicians; and a responsibility to
educate themselves about these
differences as part of making health
care decisions.
To be eligible for QualityPath™
designation the following results for
all TKA and THA procedures must
be reported by facility
Results provided to QualityPath™
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
THA/TKA case volume for each
of the past two calendar years

5 year revision rates

THA/TKA 30-day Readmission
Briefly describe how facility uses
registry data to work together with
physicians to improve quality.
All results at or better than average
1
Criteria
Transparency Physician
Rationale
Definition/Action
rate

THA/TKA Complication rate
(proportion of patients with
one or more of the following
eight complications: AMI,
pneumonia, sepsis/septicemia
during the index admission or
within seven (7) days of
admission; surgical site
bleeding, pulmonary embolism,
or death during the index
admission or within 30 days of
admission; or mechanical
complication or periprosthetic
joint infection/wound infection
during the index admission or
within 90 days of admission.)

Patient satisfaction scores
(HCAHPS) specific to orthopedic
unit(s)

Additional measures as
available through
HospitalCompare
To be eligible for QualityPath™
designation the following results for
all TKA and THA procedures must
be reported by individual physician

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Meets
Results provided to QualityPath™
Results at or better than average
THA/TKA case volume for each
2
Criteria
Standardize clinical
processes – Decision
support for ordering
high tech diagnostic
imaging tests (HTDI)
(CT, MRI, PET)
Rationale
Decision support provides
immediate help determining the
best diagnostic imaging test based
on a patient’s indication and
available evidence and best
practice. It helps physicians order
the right test the first time, saving
the cost of unnecessary or low
utility tests.
Definition/Action
of the past two calendar years

5 year revision rates

THA/TKA 30-day Readmission
rate

THA/TKA Complication rate

Patient satisfaction scores
(CAHPS Surgical Care Survey
available at
http://www.facs.org/ahp/cahps
/about-scs.html)

Additional measures as
available through Physician
Compare
To be eligible for QualityPath™
designation Decision Support when
ordering HTDI tests must be used
consistently by orthopedic practice
and affiliated/referring primary care
practice(s).
Results must be tracked and
reported by physician, by practice,
and by facility
Meets
Describe the Decision Support
process
Specific Decision support tool used
specified to QualityPath™
Results provided to QualityPath™by
physician, by group practice, and by
facility
http://www.medcurrent.com/JACR
_Jan_2011__Effectiveness_of_Clinical_Decision
_Support_in_Controlling_Inappropr
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Criteria
Rationale
iate_Imaging.pdf
Definition/Action
Meets
Standardize clinical
processes - Patients
actively engaged in
shared decision
making using a high
quality decision aid
Shared decision making ensures
that patients are informed of all
options for treating their condition
prior to the procedure, that they
understand the risks and benefits of
each option, and that they want to
proceed with a TKA or THA.
To be eligible for QualityPath™
designation the orthopedic practice
must engage all patients in shared
decision making process using a
high quality decision aid that
includes non-surgical options.
Describe the shared decision
making process
Proportion of TKA and THA patients
participating in shared decision
making must be tracked and
reported by individual physician, by
practice, and by facility
Decision aid instrument provided to
QualityPath™
Results provided to QualityPath™
by physician, by group practice, and
by facility
Multiple decision aid options are
available at:
http://decisionaid.ohri.ca/AZinvent.
php
Decision aid for non-operative
treatment vs. hip replacement
surgery available at:
http://www.optiongrid.org/resourc
es/osteoarthritisHip_grid_USA.pdf
Decision aid for treatment of
osteoarthritis of the knee available
at:
http://www.optiongrid.org/resourc
es/osteoarthritisoftheknee_grid_US
A.pdf
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Criteria
Standardize Clinical
Processes - Quality of
patient decision
making assessed using
a standardized
instrument
Rationale
Assessing the quality of shared
decision making prior to surgery
helps identify gaps in patient’s
understanding and the extent to
which the patient was actively
engaged in deciding to have TKA or
THA.
Definition/Action
To be eligible for QualityPath™
designation the quality of patient
decision making must be assessed
prior to TKA and THA procedures,
for all patients, using the specified
standardized instrument accessible
at:
http://www.massgeneral.org/decisi
onsciences/research/DQ_Instrumen
t_List.aspx
Meets
Describe the process for assessing
the quality of shared decision
making
Confirm specified instrument used
to assess decision quality
Results provided to QualityPath™
by physician, by group practice and
by facility
Proportion of THA and TKA patients
completing assessment of decision
quality must be tracked and
reported by physician, by practice,
and by facility
Standardized Clinical
Processes – Joint
School Participation
Patients should understand the
surgical and recovery process
To be eligible for QualityPath™
designation pre-procedure ‘Joint
School’ must be available. It is
expected that all QualityPath™
patients will participate.
Proportion of TKA and THA patients
completing pre-procedure joint
school is tracked in aggregate and
by QualityPath™ participants
Standardized Clinical
Processes – Patient
Reported Outcome
Measures (PROM)
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Patient Reported Outcome
Measures (PROM) document the
level of severity of pain and
functional impairment. Severity of
symptoms help assess procedural
To be eligible for QualityPath
designation there must be a process
in place to assess patient reported
pain and function before and after
surgery using standardized
Provide ‘Joint School’ curriculum
and describe the process
Results provided to QualityPath™ in
aggregate and for QualityPath™
participants by physician, group
practice and by facility
PROM instruments used provided
to QualityPath™
Results available to QualityPath™ in
aggregate participants by physician,
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Criteria
Rationale
appropriateness
Definition/Action
instruments. A minimum standard
of a pre-op assessment and one
post-op assessment completed at 6
or 12 months is required
Meets
group practice and by facility
Standardized instruments include:
• EQ -5D
• Oxford Knee
Score/WOMAC/Other
• Oxford Hip Score/Other
• Lower Extremity Activity
Scale (LEAS)
• Harris Hip Score
• Visual Analog Pain Scale
Proportion of THA and TKA patients
completing the same pre and post
PROM must be tracked by
instrument and reported by
physician, by group practice and by
facility
Standardized Clinical
Processes –
Conversation about
future care needs
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Spelling out what kind of medical
care we want if we are too ill or
hurt to express our wishes is a way
of telling our wishes to family,
friends, and health care
professionals to avoid confusion
later on.
To be eligible for QualityPath™
Results available to QualityPath™
designation there must be a process
in place to ensure documentation
that a conversation about future
care needs has occurred
Proportion of patients with
conversation documented
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Criteria
Disclose potential
conflicts of interest –
Facility
Disclose potential
conflicts of interest Physician
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Rationale
Full disclosure of potential conflicts
of interest helps ensure treatment
decisions are not influenced by
commercial interests
Full disclosure of potential conflicts
of interest helps ensure treatment
decisions are not influenced by
commercial interests
Definition/Action
To be eligible for QualityPath™
designation the facility must have a
policy on industry conflict of
interest in place that includes full
disclosure to patients
Meets
Policy provided to QualityPath™
All direct and indirect industry
payments must be tracked by
facility
To be eligible for QualityPath™
designation the orthopedic practice
must each have a policy on industry
conflict of interest in place that
includes full disclosure to patients
Direct and Indirect payments
provided to QualityPath™ annually
All direct and indirect industry
payments must be tracked by
individual physician
Direct and Indirect payments
provided to QualityPath™ annually
Example of patient disclosure (e.g.
hard copy report or website link)
provided to QualityPath™
Policy provided to QualityPath™
Example of patient disclosure (e.g.
hard copy report or website link)
provided to QualityPath™
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