Clinical Orthopaedics and Related Research®

, Volume 470, Issue 4, pp 1017–1026 | Cite as

Public Reporting of Cost and Quality Information in Orthopaedics

  • Youssra Marjoua
  • Craig A. Butler
  • Kevin J. BozicEmail author
Symposium: Value Based Healthcare



Public reporting of patient health outcomes offers the potential to incentivize quality improvement by fostering increased accountability among providers. Voluntary reporting of risk-adjusted outcomes in cardiac surgery, for example, is viewed as a “watershed event” in healthcare accountability. However, public reporting of outcomes, cost, and quality information in orthopaedic surgery remains limited by comparison, attributable in part to the lack of standard assessment methods and metrics, provider fear of inadequate adjustment of health outcomes for patient characteristics (risk adjustment), and historically weak market demand for this type of information.


We review the origins of public reporting of outcomes in surgical care, identify existing initiatives specific to orthopaedics, outline the challenges and opportunities, and propose recommendations for public reporting of orthopaedic outcomes.


We performed a comprehensive review of the literature through a bibliographic search of MEDLINE and Google Scholar databases from January 1990 to December 2010 to identify articles related to public reporting of surgical outcomes.


Orthopaedic-specific quality reporting efforts include the early FDA adverse event reporting MedWatch program and the involvement of surgeons in the Physician Quality Reporting Initiative. Issues that require more work include balancing different stakeholder perspectives on quality reporting measures and methods, defining accountability and attribution for outcomes, and appropriately risk-adjusting outcomes.


Given the current limitations associated with public reporting of quality and cost in orthopaedic surgery, valuable contributions can be made in developing specialty-specific evidence-based performance measures. We believe through leadership and involvement in policy formulation and development, orthopaedic surgeons are best equipped to accurately and comprehensively inform the quality reporting process and its application to improve the delivery and outcomes of orthopaedic care.


Quality Reporting Public Reporting Administrative Claim Data Physician Quality Reporting System National Surgical Quality Improvement Project 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Susan Epstein (Charlotte Edwards Maguire Medical Library, Florida State University, College of Medicine) for her assistance in formulating the search strategy on PubMed, and Vanessa Chiu, MPH, for assistance in preparing this manuscript.


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Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Youssra Marjoua
    • 1
  • Craig A. Butler
    • 2
  • Kevin J. Bozic
    • 3
    Email author
  1. 1.The Harvard Combined Orthopaedic Residency ProgramBostonUSA
  2. 2.North Florida Sports Medicine & Orthopaedic Center & Florida State University College of MedicineTallahasseeUSA
  3. 3.UCSF Department of Orthopaedic Surgery and Philip R. Lee Institute for Health Policy StudiesUniversity of California San FranciscoSan FranciscoUSA

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