Is there value in the osteopathic approach to care?

In my last column, I tried to make the case that osteopathic medicine, as envisioned by A.T. Still, DO, MD, is defined by an emphasis on the self-healing capabilities of the body given the proper environment—what we today are calling lifestyle medicine—and the incorporation of the body, mind and spirit into a whole-person approach to care, what might be called mind-body care today.

I also put forth the postulate that while others might practice similarly to us, this type of care has been defined as osteopathic since at least the late 1800s, and we need to stake our claim to this definition of ourselves. I want to thank all of those who commented on the article, and I’m glad to see that it has stimulated conversations across our profession.

Over the past few years, we have attempted to present to our students at Western University of Health Sciences a simple definition of osteopathic physicians. We explain that osteopathic physicians are trained in a philosophy of care that is patient-centered and health-focused; that incorporates the latest advances in biomedical science with a hands-on diagnostic and therapeutic approach called osteopathic manipulative medicine in order to provide comprehensive care to our patients.

But is there “value” in the osteopathic approach to care? If not, then we should not worry about fighting for our distinctive practice, our osteopathically recognized residency programs or our osteopathic medical schools. I’m confident, however, that the osteopathic approach to care indeed adds value to the house of medicine, and in the rest of this column I would like to make that case to you.

Defining “value”

Let us start by defining value in health care. In the past, in a largely fee-for-service environment, the value proposition was simple: patients seen or procedures performed divided by unit of time.

Today, however, that value proposition has changed. Economic forces such as value-based care, increased competition in the health care marketplace such as non-physician-led care or alternative medicine and increasing corporatization of medicine have led us to a new value proposition: patient outcomes plus patient experience divided by cost.

In this new equation, we look to incorporate the data availability created by EHRs to quantify outcomes, we use tools such as patient satisfaction surveys to estimate experiences and attempt to keep close tabs on the expenditures related to our care.

Whether we have been successful in truly measuring these elements, the equation rings true. In a value-based model, we need to make sure patients are getting the same or better outcomes with an improved experience at a lower cost. This has been called the Triple Aim by the Institute for Healthcare Improvement.

Exploring the Triple Aim

So the question before us is: Does osteopathic medicine help achieve the Triple Aim? Let’s look at each element and see what the data tells us. But before we do, I want to mention osteopathic manipulative treatment (OMT) specifically. I stated in the previous article, and I have always believed, that OMT does not define osteopathic medicine. I have known many physicians, DO and MD alike, who are osteopathic in their care without using OMT as a treatment modality.

However, while OMT does not define osteopathic medicine, it is the most visible distinction in our practice, and is therefore an easily studied element of osteopathic care. Therefore, much of the research around osteopathic medicine is really research about OMT in healthcare.

The bibliography of effectiveness of OMT for many patient presentations is large, so I’ll highlight just a few positive studies. We already know the effectiveness of OMT for low back pain, which was reaffirmed by the AOA in 2016 in the form of a guideline.

In 2016, Bagagiolo et al published a review of OMT in pediatric and neonatal patients that concluded that studies in pediatric patients tend to favor the effectiveness of OMT but are small in size. There was evidence suggesting cost savings in neonatal care as well.

Evidence and studies

Another study by Baltazar showed that OMT was effective in treating postoperative ileus and reducing the length of stay in surgical patients. Other common clinical entities which benefit from OMT include otitis media in children, concussion in athletes, pneumonia in hospitalized elderly, balance in Parkinson’s disease and so many more.

Studies documenting the effectiveness of other aspects of the osteopathic approach are a little harder to find. A 2011 article by Vergehese et al describes the value of a bedside evaluation. His team describes improved patient experience and expectations as well as changes in neurotransmitter levels.

The American College of Lifestyle Medicine posts a comprehensive database of evidence for the efficacy of lifestyle changes in disease management. The power of empathy and mind-body connection in osteopathic medical education is being studied by the American Association of Colleges of Osteopathic Medicine (AACOM).

The value of osteopathic care

The practice of osteopathic medicine, including the use of OMT, fits the definition of the Triple Aim as mentioned, and helps us as a profession to make the case that osteopathic medicine is high-value medicine.

This is further evidenced by fact that over 15% of ACGME residency programs with osteopathic recognition were never previously affiliated with AOA-accredited GME. To me, this demonstrates the value of the osteopathic approach to care within the medical community, as these program directors are specifically stating that they value osteopathically oriented residents.

Osteopathic medicine, defined as patient-centered, health-focused care incorporating hands-on diagnosis and treatment and acknowledging the self-healing capacity of the triune person, adds value to the practice of medicine. Osteopathically practicing physicians are able to improve patient outcomes, improve patient experiences and decrease costs.

This is the banner that Dr. A.T. Still flung to the breeze, the improvement in “our present system of surgery, obstetrics, and treatment of diseases generally” that he spoke of in the charter of the American School of Osteopathy in 1892, the legacy of all those DOs who have gone before. It is up to us to take that banner and fly it proudly!

Related reading:

Is there still an art to practicing medicine?

Direct primary care: A path to achieving the Quadruple Aim of health care