Share Outcomes to Build Referral Trust

Sean Zeller, MSPO, CO
Sean Zeller

Employing evidence-based outcomes is one of the most effective tactics that O&P practitioners can use to strengthen their relationships with physicians and other referral sources. Sean Zeller, MSPO, CO, orthotist with National Orthotics and Prosthetics Company (NOPCO) at Children’s Hospital in Boston, presented this idea to an audience of practitioners at the 2009 AOPA National Assembly in Seattle.

With the uncertainty surrounding health care reform in the United States, all branches of medicine are heading toward evidence-based practice as a way to prove the necessity of various treatments. Physicians and other health care practitioners are able to use others’ successful outcomes to ensure the best possible care for their own patients.

e“That’s the crux of evidence-based practice,” Zeller told O&P Business News. “We’re making decisions about what’s best for the patient based on sound evidence.”

Zeller and the team at NOPCO/Boston Brace set up a quality improvement project, beginning with the scoliosis treatment program and then branching into other specialties. They examined the care their patients received, and what the results were, and compared those to the outcomes of scoliosis patients as documented in the available research.

This process also has given the NOPCO/Boston Brace team the opportunity to revise its patient care documentation process to ensure uniform patient reporting. This consistency provides clear-cut statistics about patients.

Zeller then translates that information into a report — if 30 patients were seen this month, for example, and there were corrections of 70% and balance was improved in 85% of the cases — and compares this data to published scoliosis data to measure treatment success. When the results are unfavorable, he can determine the causes and propose corrective procedures.

The team members realized that the results of the quality improvement project likely would benefit their primary referral sources. They created simple reports with the data from that year for each physician.

He has found that physicians respond well to this effort, and are more apt to continue working with practitioners who ensure best possible outcomes for their patients.

“Physicians take the Hippocratic Oath and they want to be working with other people who feel the same way — where they do no harm and put the patients first,” he said.

Practitioners can send this information by written report, anecdotes or through videos. Videos also allow physicians to show other patients clear results.

Some might hesitate to report unfavorable outcomes, but Zeller warns against that practice.

“Our philosophy is that being open is putting our best foot forward. That’s why we do it,” he said.

Reporting outcomes forces practitioners to be accountable. These should be teaching moments, Zeller said, where practitioners examine their work and determine what they need to change to improve those outcomes.

“If you’re not getting good outcomes, you’re not going to be in practice long.”


I would agree with the contention that evidence-based practice would help strengthen our relationships with our referrals and appreciate the approach of comparing current results with established data. But what we must recognize is that in most areas of O&P practice, the research for comparison is limited.

It is true that in scoliosis there are more measurable outcomes that have been documented in literature. These include such things as the Cobb angle, decompensation and Balance Summation, to name a few. By providing this data and comparable outcomes of our patients to our referring physicians, practitioners are truly showing a dedication to achieving the best outcome possible with a quantifiable measurement.

Our referrals may also appreciate the ability to prove the success of their treatments based on the success of ours. It sets up a nice opportunity for idea exchanging between the practitioner and physician or therapist — the team approach. But we do have to understand that our studies need to be completed with enough patients to make them valuable.

Keith M. Smith, CO, LO, FAAOP
President American Academy of Orthotists and Prosthetists

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