{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T21:35:34Z","timestamp":1783805734422,"version":"3.55.0"},"reference-count":26,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,3,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE:<\/jats:title>\n                  <jats:p>Adolescent idiopathic scoliosis (AIS) is a relatively common reason for referral to orthopedic surgery, but most referred patients do not require bracing or surgery. We developed a quality improvement (QI) program within the Pediatric Physicians\u2019 Organization at Children\u2019s, an independent practice association affiliated with Boston Children\u2019s Hospital, to reduce unnecessary specialty referrals for AIS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>The QI program consisted of physician education, decision support tools available at the point of care, and longitudinal feedback of data on physician referrals for AIS. Referral patterns in the 2-year postintervention period were tracked and compared with those of the 2-year preintervention period. Clinical characteristics of referred patients were compared through claims analysis and chart review.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>Initial visits to orthopedic surgery for AIS declined from 5.1 to 4.1 per 1000 adolescents per year, a reduction of 20.4% (P = .01). Process control chart analysis showed a rapid change in referral patterns after the initiation of the program which was sustained over the 2-year postintervention period and demonstrated that 66 initial and 131 total AIS specialty visits were avoided as a result of the program.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>A QI program consisting of physician education, decision support available at the point of care, and longitudinal data feedback led to a sustained reduction in unnecessary referrals for AIS. This program can serve as a model for other programs that seek to shift the locus of care from specialists to primary care providers.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2012-2359","type":"journal-article","created":{"date-parts":[[2013,2,19]],"date-time":"2013-02-19T13:03:39Z","timestamp":1361279019000},"page":"e912-e920","source":"Crossref","is-referenced-by-count":21,"title":["A Quality Improvement Program to Reduce Unnecessary Referrals for Adolescent Scoliosis"],"prefix":"10.1542","volume":"131","author":[{"given":"Louis","family":"Vernacchio","sequence":"first","affiliation":[{"name":"Pediatric Physicians\u2019 Organization at Children\u2019s, Brookline, Massachusetts;"},{"name":"Division of General Pediatrics and"},{"name":"Departments of Pediatrics and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily K.","family":"Trudell","sequence":"additional","affiliation":[{"name":"Pediatric Physicians\u2019 Organization at Children\u2019s, Brookline, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Timothy","family":"Hresko","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Boston Children\u2019s Hospital, Boston, Massachusetts; and"},{"name":"Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence I.","family":"Karlin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Boston Children\u2019s Hospital, Boston, Massachusetts; and"},{"name":"Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanessa","family":"Risko","sequence":"additional","affiliation":[{"name":"Pediatric Physicians\u2019 Organization at Children\u2019s, Brookline, Massachusetts;"},{"name":"Division of General Pediatrics and"},{"name":"Departments of Pediatrics and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2013,3,1]]},"reference":[{"issue":"2","key":"2021120900333487000_B1","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1542\/peds.60.2.193","article-title":"Denver: a metropolitan public school scoliosis survey.","volume":"60","author":"Drennan","year":"1977","journal-title":"Pediatrics"},{"issue":"2","key":"2021120900333487000_B2","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1542\/peds.67.2.196","article-title":"Scoliosis screening: results of a community project.","volume":"67","author":"Gore","year":"1981","journal-title":"Pediatrics"},{"issue":"9","key":"2021120900333487000_B3","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.2106\/00004623-199609000-00006","article-title":"Late-onset idiopathic scoliosis in children six to fourteen years old. 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