Measure Information Form

Measure Set: Total Hip and Total Knee Replacement Inpatient (THKR-IP)

Set Measure ID: THKR-IP-5

Set Measure ID	Performance Measure Name
THKR-IP-5a	Postoperative Functional/Health Status Assessment-Hip and Knee Overall
THKR-IP-5b	Postoperative Functional/Health Status Assessment-Hip
THKR-IP-5c	Postoperative Functional/Health Status Assessment-Knee

Performance Measure Name: Postoperative Functional/Health Status Assessment

Description: Patients who completed the general health and joint specific functional status assessments within 90 days after surgery, as specified below:

Hips: [VR-12 or PROMIS-Global] AND [HOOS Jr. (6 questions) or HOOS Pain, Function Daily Living Subscales (27 questions)]

Knees: [VR-12 or PROMIS-Global] and {KOOS Jr. (7 questions) or KOOS Stiffness, Pain, Function Daily Living Subscales (28 questions)]

The assessment tool must reflect the status of the patient’s health condition, health behavior, or experience with health care from the patient’s perspective, without interpretation of the patient’s response by a clinician or anyone else (Cella et al. 2015). The assessment can be completed by phone, mail, email, or in-person.

Note: Links to the survey instruments are provided in the Selected References at the bottom of this section.

Rationale: Good orthopedic care requires knowledge of the patient’s history of musculoskeletal pain and associated limitations in daily function, along with improvements or declines seen after surgery. Standardized measures of patient-reported outcomes (PROs) can provide this information.

The American Association of Hip and Knee Surgeons (AAHKS) convened a Patient Reported Outcomes Summit for Total Joint Arthroplasty in 2015 with the goal of obtaining consensus regarding the patient-reported outcomes and risk variables suitable for total hip and total knee arthroplasty performance measures (Patient Reported Outcomes Summit for Total Joint Arthroplasty Report, 2015). The instruments specified in this measure align with the Summit’s recommendations as well as CMS Comprehensive Care for Joint Replacement legislation.

The Veterans RAND 12 item Health Survey (VR-12) is a generic patient reported outcome (PRO) instrument. It is a well validated and widely used in the hip and knee population to measure health related quality of life by capturing the patient’s physical function and health status. The Patient Reported Outcomes Measurement Information System (PROMIS) Global-10 assess patient-reported health status for physical, mental, and social well-being by measuring a patient’s pain, fatigue, physical function, depression/anxiety status, and social function. Hip disability and Osteoarthritis Outcome Score (HOOS) and Knee injury and Osteoarthritis Outcome Score (KOOS) are well validated and widely used instruments for measuring joint-specific pain and physical function before and after joint replacements. Full HOOS and KOOS surveys are lengthy, however, abbreviated versions are available as HOOS Jr./KOOS Jr.

Type Of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Number of patients who completed the general health and joint specific functional status assessments 90 days after surgery.

Included Populations: Not applicable
Excluded Populations: None
Data Elements:

ICD-10-PCS Principal Procedure Date

Postoperative Assessments Completed

Postoperative Assessments Completion Date

Denominator Statement: Patients who underwent a total hip or total knee replacement.

Included Populations:

Patients with an ICD-10-PCS Principal Procedure Code as defined in Appendix A: Table 14.01a Total Hip Replacement or Table 14.02a Total Knee Replacement

Excluded Populations:

Patients less than 18 years of age

Patients who have a Length of Stay greater than 120 day

Patients with an ICD-10-PCS Other Procedure Code as defined in Appendix A: Table 14.05a (partial hip and partial knee replacements), Table 14.06a (revision and resurfacing procedures), Table 14.07a (removal of implanted devices/prostheses)

Patients with an ICD-10-CM Principal Diagnosis Code or ICD-10-CM Other Diagnosis Code as defined in Appendix A: Table 14.08 (complication of internal fixation device/prosthesis), Table 14.09 (malignant neoplasm of the pelvis, sacrum, coccyx, lower limbs, or bone/bone marrow or a disseminated malignant neoplasm), or Table 14.10 (femur, hip, pelvic fracture)

Data Elements:

Admission Date

Birthdate

Discharge Date

ICD-10-CM Other Diagnosis Codes

ICD-10-CM Principal Diagnosis Code

ICD-10-PCS Other Procedure Codes

ICD-10-PCS Principal Procedure Code

ICD-10-PCS Principal Procedure Date

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records.

Data Accuracy: Variation may exist in the assignment of ICD-10 codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: None

Sampling: Yes. Please refer to the measure set specific sampling requirements and for additional information see the Population and Sampling Specifications Section.

Data Reported As: Aggregate rate generated from count data reported as a proportion. Proportion for hip replacements, proportion for knee replacements and aggregated proportion for hip & knee replacements.

Selected References:

Cella, D., Hahn, E., Jensen, S., Butt, Z., Nowinski, C. et al. Patient-Reported Outcomes in Performance Measurement. Research Triangle Park (NC): RTI Press; 2015 Sep.
Patient Report Outcomes Summit for Total Joint Arthroplasty Report, August 31, 2015.

Links to Patient-Reported Outcome Survey Instruments:

HOOS http://www.koos.nu/HOOSEng.pdf
HOOS Jr. https://www.hss.edu/hoos-jr-koos-jr-outcomes-surveys.asp
KOOS http://www.koos.nu/koos-english.pdf
KOOS Jr. https://www.hss.edu/hoos-jr-koos-jr-outcomes-surveys.asp
VR-12 https://www.aaos.org/uploadedFiles/PreProduction/Quality/Measures/Veterans RAND 12 (VR-12).pdf
PROMIS-Global http://www.healthmeasures.net/explore-measurement-systems/promis/obtain-administer-measures

Measure Algorithm:

Specifications Manual for Joint Commission National Quality Measures (v2021B2)
Discharges 10-1-21 through 12-31-21 (4Q21)

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