Spinal Program

Scoliosis Collaborative Initiative seeks to improve efficiency of referrals

A common reason for referrals to orthopedic specialists at Boston Children’s is adolescent idiopathic scoliosis (AIS). However, in 2009, only 40 percent of referred visits met the screened criteria for an appropriate referral based on physical exam and scoliometer readings.

Driving over-referrals were unclear guidelines, provider knowledge deficits and parental preference. And as a result, specialists’ practices were oversubscribed, with offices overcrowded and appointments running late; specialists were often seeing essentially healthy children; and the cost of care increased. Families, PCPs, orthopedic specialists and payers were all stakeholders in the goal of increasing the efficiency of AIS referrals.

Solution

The Pediatric Physicians’ Organization at Children's (PPOC)—–a group of more than 250 Massachusetts primary care physicians in 76 practices affiliated with Children’s Hospital Boston——collaborated with Children’s pediatric orthopedists to develop tools for improving the efficiency of referrals for AIS. Over the course of 18 months, the Scoliosis Collaborative Initiative developed a decision support algorithm; didactics and feedback data for clinicians; and educational handouts for parents. Relevant materials were integrated into the PPOC’s electronic medical records (EMR) via the scoliosis order set.

Results

Using the tools provided by the Scoliosis Collaborative Initiative, PPOC practices were able to decrease their AIS referrals by 24%.

In doing the study, project leaders learned that three factors are key when it comes to changing referral patterns:

• Background analysis is critical.
• Providers will make change faster if equipped with: tools (e.g., decision support algorithm) and data (e.g., performance gap analysis).
• Educating families is essential.

Read a report as presented to Harvard Pilgrim Health Care at on.chbos.org/pv0811scoliosis.