Development and alpha testing of an electronic clinical quality measure for inpatient respiratory depression following total joint arthroplasty

Ania Syrowatka, PhD
Department of Medicine
Division of General Internal Medicine and Primary Care
Poster Overview

After a hip or knee surgery, a person may start breathing slower than normal. This is called respiratory depression. If this happens, the person may not get the oxygen that they need. This can lead to severe health problems and even death. It is important to measure if healthcare is safe. Our team developed a way to calculate how many patients have respiratory depression after a hip or knee surgery. To develop the measure, we looked at other measures reported in the United States, and research from around the world. We also talked to experts who know about respiratory depression as well as hip and knee surgeries. To test the measure, we calculated the results for patients at the Mass General Brigham. Overall, we found that 3 out of 100 patients have respiratory depression after a hip or knee surgery. A lower number shows that an orthopedic practice provides safer care. Some practices did not do as well as others. For example, at one practice twice as many patients (6 out of 100) had respiratory depression after surgery. This suggests that some practices can improve the safety and quality of their care.

Scientific Abstract

Background: Respiratory depression is a serious event that places patients at risk for hypoxia, anoxia, severe brain damage, cardiac arrest, and death. The objective of this work was to develop and alpha test an electronic clinical quality measure (eCQM) that reports on the inpatient respiratory depression rate following total hip (THA) or total knee arthroplasty (TKA).

 

Methods: The eCQM specifications were informed by a review of the literature, existing clinical quality measures as well as those under development, and consultations with a technical expert panel. Alpha testing was conducted using data captured in the Mass General Brigham (MGB) electronic health record.

 

Results: 16,474 patients underwent an inpatient elective primary THA or TKA and were included for the measure alpha testing. The overall inpatient respiratory depression rate following THA or TKA was 3.31%. However, the rates varied widely by clinician group from 2.47% to 6.67%. The latter is 2x higher than the overall MGB rate.

 

Clinical implications: The notable variability between clinician groups highlights opportunities to improve the quality and safety of postoperative care. The overarching goal of our work is to obtain National Quality Forum endorsement to provide meaningful performance measurement that can be used to drive local quality improvement.

Clinical Implications
This measure shows which orthopedic practices are doing better than others. It can help patients choose where to go for safer care. Practices can improve by regularly monitoring patients and acting quickly if there are signs of a problem.
Research Areas
Authors
Ania Syrowatka, PhD, Avery Pullman, BS, Woongki Kim, BS, Stuart R. Lipsitz, ScD, Michael Sainlaire, MS, Wenyu Song, PhD, Tien Thai, BS, Troy Li, BS, David W. Bates, MD, MSc, Patricia C. Dykes, RN, PhD
Principal Investigator
Patricia C. Dykes

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