Electronic Clinical Quality Measures for Prosthetic Joint Infection Diagnosis: Pitfalls and Potential

Introduction

Prosthetic joint infection (PJI) after total hip and knee arthroplasty (TJA) is a major cause of morbidity in orthopedics. Fully specified quality measures for PJI diagnosis are lacking. We aimed to specify and evaluate electronic clinical quality measures (eCQM) across different healthcare institutions.

Methods

Measures were specified using an iterative process through which elements in the measures were identified and evaluated, and their capture optimized in the electronic health record (EHR). Measures were then retrospectively tested at three institutions. Performance on the measures at each institution, and across surgeons at one, was also assessed. Qualitative interviews with each institution identified technical, structural, and clinical reasons for poor performance on the measures.

Results

Four of the five eCQMs could be implemented within the EHRs. Wide variations were found in measure performance. Qualitative interviews revealed differences in EHR coding, data not being shared within institutions, and focus on specific tests within the testing set as reasons for poor performance.

Conclusions

Significant variability in posthetic joint infection eCQMs exists, driven both by variations in data availability and clinical practice. Electronic clinical quality measures hold significant potential to enhance diagnostic quality measurement, but successful implementation is highly dependent on process standardization, data accuracy, and adaptation of measures across healthcare settings.