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Johns Hopkins Pediatric

A Systematic Approach to Joint Replacements

Johns Hopkins Orthopaedic Surgery
February 3, 2014

Paul Khanuja: “We’re trying to learn from the best practices of all surgeons and reduce the variability. That will help lead us to an overall system standard of quality.”
If Paul Khanuja has his way, the hospitals that are part of the Johns Hopkins Health System will collectively outperform all others in the area of joint replacements—and become a model program in the United States for value-based health care.

That may be a tall order, but for Khanuja it’s not a choice. As the chief of orthopaedics for Johns Hopkins Bayview Medical Center and the chief of adult reconstruction and hip and knee replacement surgery for the Department of Orthopaedic Surgery at Johns Hopkins Medical Institutions, he believes it’s not just academic.

“Joint replacements will grow considerably, and this will increase the demand on our health care system,” Khanuja says. “Value-driven care and evidence-based medicine is where we’re obliged to go. We are fortunate to have a group of talented joint surgeons at all of our hospitals, as well as the knowledge and infrastructure to make this a reality.”

Working within the framework of the Johns Hopkins Armstrong Institute for Patient Safety and Quality, Khanuja has helped to establish a “clinical community” to standardize protocols for patient outcomes and quality measures. While the approach is not a new one—health reform has virtually mandated the concept of value-driven care—implementing procedures across a health system has stymied many groups.

Khanuja sees the challenge as an opportunity to do things better. Having already established such protocols for The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center, he has teamed up with surgeons across the system to consolidate models of care for all of the Johns Hopkins-based joint replacement programs.

All of this requires a collaborative effort to eliminate disparities in outcomes, readmissions and other surprises that ultimately affect a successful value-based model. It means analyzing processes, meticulously measuring outcome data and designing—or redesigning—practices until they are precise.

That doesn’t deter Khanuja, given the support of the Armstrong Institute and orthopaedic specialists from all of the Johns Hopkins hospitals. Among their directives: to develop best practices and design value metrics, as well as to improve registry and data systems and create standards for patient education. Ultimately, there will be a governing council to measure metrics and oversee accountability.

“What we’re really doing here is turning what are already solid individual programs into a stronger system-wide program where there is less variability,” says Khanuja. “That’s where the value is for patients, hospitals and providers.”

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