by George J. Barnes II, AOPA Government Affairs Department

Although many O&P professionals have heard the call for Evidence-Based Practice (EBP), to some, it still remains ambiguous and unnecessary. The truth is, however, that EBP isn’t just for academic researchers; it’s a cost-effective system that can boost patient care. 

At its essence, EBP is simply an approach to decision making: Evidence, along with expert opinion, determines best practices. To collect such data, one uses outcomes research. This type of research seeks to understand the end results (or outcomes) of a particular practice or treatment. 

In O&P’s case, outcomes research can ask general questions such as whether patients do better with or without prostheses, or can ask specific questions such as which specific device best improves a patient’s ability to walk. This type of thinking was highlighted in the 1980s when physicians realized that certain treatments worked with some patients, but not with others. The only way to determine and understand such an inconsistency was through outcomes research. 

Practical Benefits 
There are several distinct reasons for incorporating outcomes research into your practice, including 

• Better patient care. The ultimate goal of outcomes research is to better understand the end results of practices so that patient care can become more effective. The Agency for Healthcare Research and Quality says that outcomes research “provides evidence about benefits, risks, and results of treatments so [practitioners] can make more informed decisions.” Better decision making directly facilitates better treatments for patients, which improves their quality of life. 


• Cost-effectiveness. Outcomes research often measures how cost affects the results of treatments and interventions. Two important distinctions in EBP are how much does effective treatment cost, and how much should effective treatment cost. The difference is important because the relationship between cost and care can determine how many patients receive appropriate attention. For example, if various treatments and interventions have different costs, but the same effectiveness, then choosing the treatment with the lowest cost doesn’t dilute patient care. Cost-effectiveness also can examine the cost and benefit of preventive interventions. This would give a factual basis for determining if preventive measures are the best course of action. 


• Increased income. In today’s information-based society, data often can translate into dollars. For instance, many insurers are looking for evidence and data to justify reimbursement for certain services. Even the CMS have established the Medicare Evidence Development & Coverage Advisory Committee to examine “data and information on the effectiveness and appropriateness of medical items and services” that Medicare covers. Many have suggested that coverage justification soon will be based on evidence, and without evidence, practitioners have a harder time explaining reimbursement with payers. In addition, there is a push right now at CMS to include a requirement of significantly improved medical outcome or significantly superior clinical outcome before a new code is allowed.


• Identification of gaps between evidence and practice. Because practice is sometimes only determined by expertise, practitioner experience, and industry tradition, normal treatment procedures frequently can be effective for certain populations and ineffective for others. Outcomes research can identify those areas of ineffectiveness and provide data to develop effective treatments. 

Major Challenges 
We all know that implementing evidence-based practice through outcomes research is no easy task. First, it requires a general consensus among many professionals across O&P. Outcomes data is only good if it represents an accurate picture of the whole O&P community. For that to happen, it requires participation from practitioners and facilities. In order for outcomes data to make broad assertions, there has to be sampling from a broad base of participation, which entails getting a lot of people involved in data collection. 

Second, there are many different types of data practitioners can collect. Identifying the types of data that are important and the best way to collect them involves a lot of stakeholders.

In the Journal of Prosthetics and Orthotics, Dr. Douglas Smith identifies some challenges that complicate outcomes research in, for example, amputation surgery and prosthetic rehabilitation. They include developing a valid and reliable outcome survey tool that documents socket fit and comfort, understanding the routine variation in activity for lower limb amputees using prosthetic devices, and defining and measuring how much time is appropriate for adjusting to new prosthetic components. Smith also suggests that complex outcomes research methods, among other factors, lead to lengthy outcomes studies, which become extremely expensive. 

EBP’s Future 
Outcomes research and EBP have been topics of interest among many O&P professionals. However, it may seem at times that funding and outcomes research has been slow to come to fruition. This has motivated O&P professionals to work even harder to ensure the implementation. 

A joint effort between AOPA and the American Academy of Orthotists & Prosthetists (AAOP) led to the creation of the Outcomes Research Initiative. This initiative is tasked with furthering EBP in the O&P community through facilitating outcomes research. The initiative’s steering committee, which is composed of practitioners, industry experts, and educators, also seeks to create a mechanism for disseminating outcomes data. 

The outcomes initiative recognizes the challenges that the field faces, and the committee is working fervently to address obstacles and to foster creativity and efficiency in implementing EBP. The future of outcomes research continues to develop in full force, based on collaboration, communication, expertise, and strategic innovation. 

George J Barnes II is the program manager for AOPA’s Outcomes Research Initiative. Reach him at gbarnes@AOPAnet.org or call 571/ 431-0859.