"Our goal is to determine which aspects of the clinical encounter are most helpful to patients," explained Cheryl Hawk,DC,PhD, associate professor at the Palmer Center for Chiropractic research and principal investigator for the study. "It's relatively easy for DCs to participate. They fill out a three-page survey regarding practice characteristics, then their staff simply hands out questionnaires to the first 20 patients in a given week. Since the completed forms are sealed in an envelope and sent directly to us, patient confidentiality is assured."
While most indications are that chiropractic patients are generally quite satisfied with their care, the hypothesis is that aside from the adjustment, there are several other aspects of clinical practice that contribute to this satisfaction. The researchers feel that many aspects of the chiropractic clinical encounter have not yet been extensively studied.
Overview of Study Design
This observational study will be conducted in two parts: 1) a qualitative study analyzing aspects of the doctor-patient encounter; and 2) a quantitative study collecting data on patient satisfaction and practice characteristics.
Qualitative Study - Videotaping of the Clinical Encounter
From the offices already participating in the Palmer practice-based research program, five to 10 chiropractic offices will be selected on the basis of geographic diversity and diversity in practice style. Under the direction of Robert Jansen, PhD, of Palmer West, clinical encounters will be videotaped and coded using the Davis Observation Code. This code has been used to categorize clinical behaviors and has been used extensively in family medicine for analyzing physician-patient interactions
Quantitative Study - Components of Primary Care, Practice Characteristics, and Patient Satisfaction
Data will be collected by the established methods of the Palmer Practice-Based Research Program, which has been in operation since 1995. The researchers hope to achieve geographic representation from all states and participation of DCs with a variety of practice styles, with approximately 150-200 offices expected to participate.
Data Collection
Each participating practice will be asked to enroll all patients into the study on the given dates, until 20 patients have been enrolled. Patients who complete the four-page booklet will receive a spine key chain as an incentive. Each participating practice and practitioner will be asked to complete a two-page survey about practice characteristics. The practice and practitioner questionnaires are only completed once, not for each patient.
The Questionnaires
The patient questionnaire is composed of two main instruments: 1) the Components of Primary Care, developed by the Department of Family Medicine at Case Western Reserve University and used with their permission; and 2) The satisfaction questionnaire, developed by researchers at the RAND corporation specifically for chiropractic patients and used with permission of its authors (Ian Coulter, et al.). The practice and practitioner forms are adapted from those used in previous Palmer practice-based research projects.
Duration
The study will be conducted over a one-week period in the fall of 1999, and the data collection will often be completed in 1-2 days.
Recruitment
Doctors of chiropractic who are licensed and in practice in the U.S. or Canada are eligible. To achieve geographic diversity, the researchers are actively recruiting doctors in: Alabama; Delaware; Hawaii; Louisiana; Mississippi; Nevada; South Dakota; Utah; and Wyoming. There is representation from all other states, although this does not rule out the participation of doctors in those states already covered.
Participating DCs will be given a data summary, acknowledged by name in any resulting publications, and be given reprints of any published articles. To participate, contact program coordinator Karen Boulanger at the Palmer Center for Chiropractic Research at 1-800-682-1625 or via e-mail at
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