NJR Working Groups

The Data Alignment and Methodology Oversight Group (DAMOG) provides strategic oversight of how data are processed, analysed and reported across the National Joint Registry.

DAMOG was established to ensure that NJR outputs are underpinned by consistent, transparent and robust methodology, regardless of where analysis is undertaken. Its role is to oversee alignment across NJR reporting products, improve consistency in statistical approaches, and act as the central decision-making body for changes to methodology affecting NJR outputs.

The group oversees work spanning NJR surgeon, unit and implant performance reporting, the Annual Report, supplier feedback reports, clinician and management feedback, online reporting tools, research datasets and external data extracts.

The main functions of the DAMOG are:

• overseeing programmes of work to align analytical outputs across the NJR
• reviewing data management, cleaning, validation and extraction pathways
• approving changes to statistical methodology used in NJR outputs
• overseeing implementation of recommendations from independent methodology reviews
• improving transparency around data cleaning and analytical processes
• ensuring NJR metrics remain robust, credible, defensible and easy to understand

DAMOG works closely with other NJR committees, including the Implant Scrutiny Committee, Surgical Performance Committee and Editorial Committee, to ensure NJR analysis continues to meet the needs of patients, clinicians, researchers and stakeholders.

The group reports directly to the NJR Executive Committee.

Our Minimum Data Set (MDS) is the specification of the data items that hospitals submit to the registry, and this is reviewed by a specialist group every few years to ensure we are capturing the right information and to update with newer developments such as robotic surgery which have been increasingly used in recent years.

The purpose of the MDWG is to review and provide guidance on any proposed changes to the NJR minimum dataset for the different primary and revision joint replacements covered by the NJR. The MDSWG reports to the Chair of the NJR Data Quality Committee, currently Mr Derek Pegg.

The main functions of the MDSWG are:

• To ensure version control is accurately recorded within the registry.

• To review and consider:
  • The need to keep the MDS up to date and enable monitoring of changes in practice.
  • The need to be able to analyse the data collected.
  • The effect of changes on the structure of the database maintained and the subsequent effect on NJR structures and outputs.
  • The effect of any changes on the data already held in the database and whether such changes would lead to a restriction in the size of the dataset available for analysis.
  • To ensure standard definitions of interventions and end points of interest are maintained across all of the MDS forms.
  • Any cost and administrative changes that may be imposed by changes.
  • Scientific scrutiny of proposed changes
    • Any other factors that the group consider relevant.
• To make recommendations on changes to the MDS to the NJR Board (NJRB).

The NJR Board (NJRB) agreed to develop a strategy for the collection of NJR-led patient-reported outcomes measures (PROMs) and a group was brought together to include our patient representatives to determine the viability of NJR-led PROMs activity including appropriate instruments, mode of administration, timing of collection and other practical considerations.

The PROMs working group reports to the NJR Research Committee. Professor Mark Wilkinson is the Chair of the group and the Research Committee

The main functions of the group are:

• To develop an outline of options and business case for pilot work.
• To assess the feasibility of delivery of a programme of PROMs data collection.
• To develop links with key stakeholders including the national PROMs programme and key NHS delivery partners carrying out routine PROMs nationwide.
• To evaluate possible modes of administration including paper-based and electronic methods.
• To evaluate opportunities by reviewing PROMs activity in other territories.
• To consider appropriate instruments for each cohort of patients, using the best available evidence.

The NJR currently undertakes outlier analysis for hips and knees for implants, surgeons and hospitals. Following work to improve the data quality for shoulder procedures within the NJR, it is recognised that the NJR could extend the scope of this work to include upper limb joints.

The purpose of our SWG is to explore the viability of reliable outlier analysis for shoulder and elbow implants, units and surgeons and develop proposals for their management within the NJR to promote patient safety. The SWG reports to the NJR Implant Scrutiny Committee (ISC). The Chair of the group is Professor Amar Rangan.

The main functions of the SWG are:

• To evaluate any other factors that the group consider relevant.
• To explore the viability, timeline and processes in order for the NJR to manage upper limb outliers in relation to implants, hospitals and surgeons.
• To review considerations for the inclusion of PROMs to support outlier status.
• To assess the impact of any proposed process to manage shoulder outliers in relation to other NJR outputs including:
  • Outlier analysis for implants, surgeons and hospital.
  • Implant analysis included in the Annual Report and reported on at brand level.
  • Outputs including NJR supplier feedback data files and IQM reports.
  • NJR Price Benchmarking for trust and surgeon summary reports.
• To agree criteria to confirm when an implant brand can be divided or merged.
• To ensure any processes for the management of upper limb outliers are in scope with the purpose of the NJR.
• To make recommendations on the process to manage upper limb implant, hospital and surgeon outliers to the NJR Board, NJR Surgical Performance Committee and NJR ISC Committees.