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Letters to the Editor  |   July 2008
DOs Need to Define Value of Osteopathic Medicine
Author Affiliations
  • Richard J. Snow, DO, MPH
    Clinical Assessment Program
    Program Director
  • Michael A. Seffinger, Do
    Bureau of Osteopathic Clinical Effectiveness and Research
    Chair
  • Sharon L. McGill, MPH
    Division of Quality Programs, American Osteopathic Association, Chicago, Ill
    Director
  • Richard A. Vincent, MBA
    Osteopathic Heritage Foundation, Columbus, Ohio
    Chief Executive Officer
Article Information
Neuromusculoskeletal Disorders / Osteopathic Manipulative Treatment / Pain Management/Palliative Care / Professional Issues / Low Back Pain / OMT in the Laboratory
Letters to the Editor   |   July 2008
DOs Need to Define Value of Osteopathic Medicine
The Journal of the American Osteopathic Association, July 2008, Vol. 108, 319-321. doi:10.7556/jaoa.2008.108.7.319
The Journal of the American Osteopathic Association, July 2008, Vol. 108, 319-321. doi:10.7556/jaoa.2008.108.7.319
To the Editor:  
While proponents of osteopathic medicine cite osteopathic manipulative treatment (OMT) as one of the overt measurable behaviors that delineate the unique features and demonstrate the value of our profession, researchers have been developing methodologies to better quantify the effect of OMT on patient outcomes. As of 2008—116 years after the founding of the first school of osteopathic medicine—these efforts have yielded mixed results. Research has shown that when there is an emphasis on manual diagnosis and treatment for patients with musculoskeletal disorders, osteopathic physicians demonstrate a distinctive approach to patient care, compared with their allopathic colleagues.1 However, there is little evidence to support such a distinction between osteopathic and allopathic physicians in regard to other medical conditions.2 
Certainly, there is evidence for the beneficial effects of OMT for patients with low back pain, as was recently reported in a systematic review of randomized clinical trials by investigators at The Osteopathic Research Center in Fort Worth, Tex.3 In evaluating the effect of OMT on patients' respiratory conditions for a chapter in Foundations for Osteopathic Medicine, Gilbert E. D'Alonzo, Jr, DO,4 concluded the following: 

Osteopathic physicians are convinced of the efficacy of manipulative treatment. Our experience has been that this form of therapy is helpful for our patients. There are limited data demonstrating the clinical efficacy of manipulative intervention in certain disease states. It is imperative that further clinical investigation be pursued to advance the science of osteopathic medicine.

 
Few randomized controlled trials have evaluated the effectiveness of OMT or other aspects of osteopathic medicine for conditions other than low back pain. To fill this gap, researchers are currently involved in a number of randomized controlled trials that focus on the unique contribution that osteopathic medicine makes to patient outcomes. 
Most educators in osteopathic medicine believe that—beyond the use of OMT—a unique philosophy of practice distinguishes the osteopathic medical profession from its allopathic counterparts, and that this philosophy contributes to improved outcomes in patients. With patients, private insurers, and government healthcare agencies increasingly demanding evidence to support the value of the more than $2 trillion spent annually on healthcare in the United States,5 the need to demonstrate osteopathic medicine's distinctive contribution to healthcare is growing dramatically. 
Evaluation of the unique contribution of osteopathic medicine needs to expand to include broader measurements of how osteopathic physicians prevent disease, maintain health in individuals who have no illnesses, and sustain health in patients who have chronic diseases. These broader measurements would evaluate not only the use of medications and other conventional treatments, but also physician interaction with patients, and patient motivation; coordination with available community and healthcare resources; and ability to manage systems-based care and track progress toward healthcare goals at both the patient and population-at-large levels. Such an approach would be consistent with the principle of osteopathic medicine that emphasizes treating the whole person with all available evidenced-based modalities and preventive services—including OMT when appropriate. 
Various unique dimensions that reflect the value of osteopathic medicine can be found in a study by Carey et al6 that evaluated differences in patient interactions with osteopathic vs allopathic physicians. Using a 26-item index of current osteopathic principles derived from the original principles of Andrew Taylor Still, MD, DO, researchers found that the patient interactions of osteopathic physicians were easily distinguishable from those of allopathic physicians. According to these researchers,6 DOs were more likely than MDs to use patients' first names, explain etiologic factors, and discuss the social, family, and emotional impact of illness with patients. 
The results of Carey et al6 were consistent with the holistic and systematic approach to patient treatment taught during the training of primary care osteopathic physicians, and they may be reflective of the philosophical differences in education and training that DOs receive compared with MDs. However, research has not demonstrated if osteopathic physicians are more, less, or equally effective when compared with allopathic physicians in terms of managing the health of patients and populations. 
Determining the unique contribution of osteopathic medical care should be a top priority in the profession's research agenda. The Osteopathic Heritage Foundation and the Foundation for Osteopathic Health Services are currently investigating methodologies and hypotheses for the development of a registry to identify, measure, and document the unique values of osteopathic medical care. Capturing appropriate clinical data through a registry mechanism, such as the American Osteopathic Association's Clinical Assessment Program (AOA CAP), is a key factor in such an evaluation. 
While researchers working with the Osteopathic Heritage Foundation and the Foundation for Osteopathic Health Services are focusing on defining the unique attributes of osteopathic medicine, an opportunity also exists for practicing osteopathic physicians to define—at a practice level—their individual contributions to the health of their patients. The AOA CAP registry provides the framework for DOs to define the frequency of their evidence-based practices and the outcomes of their patient care. The information captured through AOA CAP can be used to improve medical care through such activities as changing practice patterns, engaging patients in self-management, and marketing the value of osteopathic medical care to patients, employers, and private and public insurance entities. 
Recently, the Centers for Medicare and Medicaid Services (CMS) invited AOA CAP to join a congressionally mandated pilot project that will test the ability of registries to interact with the Physician Quality Reporting Initiative (ie, CMS Value-Based Purchasing Program).7 Other registries that were invited to participate in this pilot project include those of the American College of Cardiology's National Cardiovascular Data Registry and the Society of Thoracic Surgeons. Some DOs may see participation in the CMS program as an additional burden that will interfere with patient care. However, we see it as an opportunity for osteopathic physicians to define—at a community and national level—their commitment to a quality healthcare agenda, as well as a means for improving patient care. 
Since its inception, osteopathic medicine has flourished and contributed to medical care in the United States. Perhaps it is now time to define the intrinsic value of that contribution. 
 Editor's Note: Dr Seffinger serves as a member of the Editorial Advisory Board for JAOA—The Journal of the American Osteopathic Association.
 
Sun C, Desai GJ, Pucci DS, Jew S. Musculoskeletal disorders: does the osteopathic medical profession demonstrate its unique and distinctive characteristics? J Am Osteopath Assoc. 2004;104:149-155. Available at: http://www.jaoa.org/cgi/content/full/104/4/149. Accessed July 3, 2008.
Licciardone JC. A comparison of patient visits to osteopathic and allopathic general and family medicine physicians: results from the National Ambulatory Medical Care Survey, 2003-2004. Osteopath Med Primary Care. 2007;1:2. Available at: http://www.om-pc.com/content/1/1/2. Accessed July 3, 2008.
Licciardone JC, Brimhall AK, King LN. Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials [review]. BMC Musculoskelet Disord. 2005;6:43. Available at: http://www.biomedcentral.com/1471-2474/6/43. Accessed July 3, 2008.
D'Alonzo GE Jr, Krachman SL. Pulmonology. In Ward RC, ed. Foundations for Osteopathic Medicine. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2003:514 .
Poisal JA, Truffer C, Smith S, Sisko A, Cowan C, Keehan S, et al. Health spending projections through 2016: modest changes obscure part D's impact [review]. Health Aff (Millwood). March–April 2007;26:w242-w253. Published February 21, 2007.
Carey TS, Motyka TM, Garrett JM, Keller RB. Do osteopathic physicians differ in patient interaction from allopathic physicians? An empirically derived approach. JAm Osteopath Assoc. 2003;103:313-318. Available at: http://www.jaoa.org/cgi/reprint/103/7/313. Accessed July 3, 2008.
PQRI 2008 registry pilot testing participants. Centers for Medicare and Medicaid Services Web site. Available at: http://www.cms.hhs.gov/PQRI/Downloads/PQRI_2008_Registry_Pilot_Testing_Participants.pdf. Accessed July 3, 2008.