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Arthroplasty registers and their international body, the international society of arthroplasty registries (ISAR) seek to improve outcomes for individuals receiving joint replacements; at face value, register data forms part of a VBHC approach. This study explored the symbiotic relationship between register data and VBHC and contributions between registers and evidence-based medicine (EBM), quality improvement and pathways.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study used exploratory, semi-structured interview methods with a sample of regionally, nationally, and internationally recognised register experts. Fifteen participants were provided with some contextual questions prior to the interview. Interviews were held using online technology, and transcriptions stored and analysed using NVivo software. The thematic analysis was performed using qualitative coding to seek trends in experts\u2019 views on registers with a confirmatory coding and analysis undertaken by a social science researcher.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Improved patient outcomes and linking value to care by contributing to EBM as part of the function of the registers were supported by interviewees and interviews revealed the importance of clinician-led registers in the integration of outcome measures and the implementation of an evidence-based practice. By providing the four stakeholders (the patient, the clinical teams, the health system, and the society) with information to improve decision-making protocols, support clinical decisions on effective implant choices and pre- and post-operative care regimes, registers have contributed to improved outcomes. The role of the registers in supporting the development of arthroplasty pathways was found to be more ambiguous and variable across territories and between practitioners. Whilst the focus of the registers has been on improving outcomes, cost-savings for the healthcare systems were considered a bonus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The analysis supports a link between the principles of VBHC including the aim to reduce unwarranted variations, and the evidence-generating potential of arthroplasty registers, outlining a common purpose in improving outcomes and value for patients, surgical teams, healthcare organisations and society. Further research is planned to refine views and provide further insights in the complete pathway and potential symbiosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12913-026-15593-w","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T11:57:12Z","timestamp":1789473432000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The \u201csymbiosis\u201d between high-quality register data and value-based health care and the role of local, national, and international registers in the development and promotion of value-based healthcare projects"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4919-7409","authenticated-orcid":false,"given":"Peter","family":"Cnudde","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ola","family":"Rolfson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louisa","family":"Huxtable-Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"issue":"11","key":"15593_CR1","first-page":"1869","volume":"467","author":"RA Brand","year":"2009","unstructured":"Brand RA, Ernest Amory Codman MD. 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