Article Text

Download PDFPDF
Development of quality of care indicators for patients undergoing total hip or total knee replacement
  1. N F SooHoo,
  2. J R Lieberman,
  3. E Farng,
  4. S Park,
  5. S Jain,
  6. C Y Ko
  1. UCLA School of Medicine, Los Angeles, California, USA
  1. Correspondence to Nelson F SooHoo, UCLA School of Medicine, 10945 Le Conte Avenue, PVUB 3355, Los Angeles, CA 90095, USA; nsoohoo{at}


Objective The objective of this study was to develop evidence-based quality indicators to measure key aspects of care that can be targeted to decrease variations in complication rates between surgeons performing total joint replacement.

Design RAND/University of California, Los Angeles (UCLA) modified-Delphi expert panel method. To accomplish this objective, a proposed set of quality of care indicators was developed through a comprehensive literature search and structured interviews with expert clinicians. An expert panel of orthopaedic surgeons was then convened to rate the validity of these quality indicators using the RAND/UCLA Appropriateness Method. Indicators were classified as valid by the panel based on the median panel rating and the amount of dispersion of panel ratings.

Results There were 101 candidate indicators of quality identified in the six domains of preoperative processes of care, intraoperative processes, postoperative processes, implant selection and the use of new technology, privileging of hospitals and surgeons, and outcomes and comorbidity assessment. A total of 68 of the 101 indicators were rated as valid with statistical agreement.

Conclusions This study identifies measures of structure, process and outcome rated as valid quality indicators for hip and knee replacement. This project provides tools to measure and improve quality of care for patients undergoing total joint replacement.

  • Total knee arthroplasty
  • total hip arthroplasty
  • quality of care
  • quality measures
  • quality indicators
  • quality improvement
  • quality of care

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding Orthopaedic Research and Education Foundation, 6300 North River Road, Suite 700, Rosemont, IL 60018-4261.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the UCLA School of Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.