10 years of Catalonian Register of Arthroplasty (RACat)

Olga Martinez and Laia Domingo. Evaluation Area, AQuAS

The Catalonian Register of Arthroplasties (RACat) was set in motion in 2005 as an initiative of the Catalan Health Service (CatSalut), the Catalan Society of Orthopaedic and Traumatology Surgery (SCCOT) and AQuAS (at the time, the Agency for Information, Evaluation and Quality in Health).

Thus, a population register designed to assess the hip and knee arthroplasty effectiveness and safety, was born offering insights into the hospitalizations variability, the procedures and models used for arthroplasty, the survival of the implanted prosthesis and implants traceability and creating indicators for assessing the quality of health care (performance and benchmarking).

Different international previous experiences pointed to the fact that the existence of arthroplasty registers has contributed to reducing variability and improving the effectiveness, safety and quality of arthroplasty¹. This fact, coupled with the growing need to respond to several research and clinical management questions highlighted the need to set the RACat in motion.

Operation

Throughout these 10 years, more than 50 centres of Catalonia’s comprehensive public healthcare system (SISCAT) have collaborated by regularly and voluntarily forwarding their data, making it possible that for the period between 2005 and 2014 information about 45,135 primary hip arthroplasties with 5,051 revisions and 58,798 primary knee replacements with 6,473 revisions was provided.

Obtaining the information to feed into the RACat was designed to take up a minimum of workload for all those involved, especially for services of orthopaedic and traumatology surgery. Information available in hospitals is used as well as information provided by the manufacturers and distributors of prostheses marketed in Catalonia, and other databases that complement this information (MBDS, Insurance Database and others). In 2006, as part of a second phase of development of RACat, surgical forms were designed aiming to complement the collection of clinical data and promote a unique form template for Catalonia. Initially, a pilot test was carried out in 7 hospitals and from 2013 was implemented within the RACat information system. Currently, one of the main challenges of RACat is the effective surgical file implementation in all participating centres, in order to provide data and relevant intervention techniques for the results analysis.

Data analysis and assessing search

When the project began, the results spotlight fell on the review of the collected information quality, the comprehensiveness and coverage regarding the MBDS (RACat reference template)². In a second phase, and as a result of hospitals’ improvement in service reporting, the RACat opened a new avenue of analysis in order to identify and describe the variability in hospitalizations and procedures for arthroplasty, using the SISCAT^3-4 Variations Guides.

The gradual increase in the patients’ follow-up timeframe allowed the onset of the first robust survival analysis⁵, both in terms of prosthesis and of patients. And more recently, facilitating benchmarking for centres as well as for models and types of prostheses, is another priority.

On the other hand, over the past ten years, the register has featured in many research projects, mainly at national level, a fact leading to its improvement, and established and strengthened the relationship between centres and professionals, whilst providing valuable data for clinicians, managers and service planners.

Lessons learned and future challenges

RACat has proven to be a useful tool for tracking trends in hip and knee replacements, for describing and identifying factors associated with failures or prosthesis revision and for analyzing variations in the characteristics of the prostheses and procedures among hospitals and health areas in Catalonia and as a valuable tool for post-commercialization^6-7. surveillance. The continued interest of decision makers and stakeholders involved in orthopaedic hip and knee surgery coupled with the availability of hospitals’ and CatSalut’ computer data led to the consolidation of RACat as a Health Register in Catalonia.

Looking ahead, the RACat continues to face new challenges such as the incorporation of other sources of information (e.g. Primary care), involvement of private hospitals, the consolidation of international relations with the International Society of Arthroplasty Registries (ISAR) and the International Consortium of Orthopaedic Registries (ICOR), or the inclusion, through specific questionnaires, of health outcomes information and perceived quality of patients’ life. It is expected that these new goals will allow to further enrich the information and registration possibilities, to continue being a reference tool for professionals involved in orthopaedic hip and knee surgery.

The 10 Years of RACat Registry Day

To celebrate the 10th anniversary of RACat Register, a clinically revealing session is expected to take place in a meeting with the Catalan Society of Orthopaedic and Traumatology Surgery and CatSalut on 9th of December, 2015. Professional experts from different fields of health care and management, research, industry and government will be invited and the objective is to share knowledge and different views on the scope and implications of such procedures.

You can sign up and check the day’s program at: http://bit.ly/Racat10anys

References: 

1. Serra-Sutton V, Allepuz A, Espallargues M, MV Pons J. Revisió de registres d’artroplàsties: experiències internacionals. Barcelona: Agència d’Avaluació de Tecnologia i Recerca Mèdiques. Servei Català de la Salut. Departament de Salut. Generalitat de Catalunya; 2008.
2. Serra-Sutton V, Martínez O, Allepuz A, Espallargues M, Nardi J, Pallisó F, Coll M. Registre d’artroplàsties de Catalunya. Resultats de maluc i genoll 2005-2008. Revista de Cirurgia Ortopèdica i Traumatologia 2011; 1:58-74.
3. Artroplàstia primària de genoll (2005-2012). Atles de variacions del SISCAT, número 1. Barcelona: Agència de Qualitat i Avaluació Sanitàries de Catalunya. Departament de Salut. Generalitat de Catalunya; 2014.
4. Artroplàstia primària de maluc (2005-2012). Atles de variacions del SISCAT, número 2. Barcelona: Agència de Qualitat i Avaluació Sanitàries de Catalunya. Departament de Salut. Generalitat de Catalunya; 2014.
5. Serra-Sutton V, Tebé Cordomí C, Martínez Cruz O, García-Altés A, Espallargues M. En nom del Comitè Assessor i de Direcció del RACat. Registre d’artroplàsties de Catalunya. Segon informe dades 2005-2010. Barcelona: Agència d‟Informació, Avaluació i Qualitat en Salut. Servei Català de la Salut. Departament de Salut. Generalitat de Catalunya; 2012.
6. Allepuz A, Serra-Sutton V, Martínez O, Tebé C, Nardi J, Portabella F, Espallargues M. Los registros de artroplastias como sistemas de vigilancia poscomercialización: el Registro de Artroplastias de Cataluña. Revista Española de Cirugía Ortopédica y Traumatología. 2013;57(1):27-37.
7. Allepuz A, Martínez O, Tebé C, Nardi J, Portabella F, Espallargues M; Catalan Arthroplasty Register. Joint registries as continuous surveillance systems: the experience of the Catalan Arthroplasty Register (RACat). J Arthroplasty. 2014 Mar;29(3):484-90.