Why Practice Guidelines?
Each day, the cry for health care reforms grows louder and louder.
"About 35% of all surgical deaths and 50% of postoperative complications, such as infection, are probably preventable."Third party payers have been instituting their own reforms and standards for years. As the financial pressures continue to mount, these indiscriminant standards have continued to erode the ability of the chiropractic profession to be reimbursed."As many as one-fourth of all patients who die in hospitals may have been misdiagnosed by physicians."
"Up to 35% of all hospital admissions are not needed."
"Some 15% to 30% of diagnostic tests don't help or aren't even looked at."
"Already the U.S. spends more on health care per person than France and West Germany, and nearly twice as much as Britain."
In December 1989, the U.S. Congress (which usually moves only after the public outcry has become unbearable) created the Agency for Health Care Policy and Research (AHCPR) in response to four major reports from public agencies which expressed concern over medical standards and called for a national effort to establish health care practice guidelines. (Please see related "DC" article in the March 1, 1991 issue, "Chiropractic Cost Comparison Presented at AHCPR Conference.") The AHCPR, which is an agency under the U.S. Department of Health and Human Services, became responsible for the development and maintenance of health care practice guidelines.
Now, every health care profession, as well as each specialty is scrambling to develop practice guidelines before the various governmental agencies and third party payers do it for them. Fortunately, the chiropractic profession is not left behind in this effort. In fact, recent efforts by the profession in chiropractic research and the work of the RAND corporation have put the chiropractic profession ahead of many other health care providers. (Please see "Chiropractic Research at the RAND Corporation," "The Development of Chiropractic Standards of Care," and "Interview on June 6, 1990 -- Robert Brook, M.D." in the December 19, 1990 issue.)
What are practice guidelines? According to the AHCPR, practice guidelines are defined as "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances."
Practice guidelines are NOT standards. They are simply what they suggest: guidelines. They are designed to provide maximum treatment choice for the doctor of chiropractic while facilitating the greatest possible quality of care for the patient.
How are guidelines used? Practice guidelines are used for: education, quality improvement, research, risk management, and reimbursement.
The 1992 Quality Assurance Conference (The Mercy Center Conference)
The Quality Assurance Conference has been sponsored by all of the major chiropractic organizations in North America:
Congress of Chiropractic State Associations (COCSA) American Chiropractic Association (ACA) Canadian Chiropractic Association (CCA) International Chiropractors Association (ICA) Association of Chiropractic Colleges (ACC) Federation of Chiropractic Licensing Boards (FCLB) Foundation for Chiropractic Education and Research (FCER)
This is the first time in the history of the profession that all of these organizations have joined together to make this kind of development possible. This initial consensus will demonstrate to the rest of the health care world how unified the chiropractic profession is on the important issues.
In addition, several private companies have also donated money to become cosponsors of the conference: Nutri-West, SuperFeet, World-Wide Chiropractic Placement Service (WCPS), Foot Levelers, Activator Methods, OUM Group, Inc., and the Motion Palpation Institute (MPI).
The conference is to be chaired by Scott Haldeman, D.C., M.D., Ph.D. with David Chapman-Smith, L.L.B.(Hons) acting as legal counsel. While neither Dr. Haldeman or Mr. Chapman-Smith will have any input on the content of the 15 topics, they both have invaluable experience which will facilitate the process.
The conference is scheduled for January 25 - 30, 1992, in San Mateo, California. The site will be the Mercy Center, a retreat center situated on 40 beautiful acres. The profile of the conference location is one that can accommodate the conference with some seclusion and is close to a major airport.
The conference proceedings will be published immediately following the conference. Dr. Haldeman and Mr. Chapman-Smith will each edit the text prior to publication. The publication will be 400 - 500 pages in length with a soft binding. In order to allow the proceedings to be indexed, a condensed report will be submitted to an indexed journal for publication.
It is the goal of this conference to allow the proceedings to experience the greatest possible dissemination at the lowest possible cost. National and state associations, as well as other sponsors, will be encouraged to purchase the copies of the initial printing, at a price very close to cost, and provide these copies to their members as a membership service.
After considering all possible formats, a combination of a Nominal Group and the National Institute of Health (NIH) Consensus Development methods was chosen for the process of consensus among the members of the conference. The committee captains will be responsible for coordination of their respective topics and finalizing all drafts.
The topics for this conference are divided into three separate areas of concern; within each area are five topics. They are as follows:
Initial Patient Evaluation:
History and Physical Examination
X-ray and Other Imaging
Instrumentation
Clinical Laboratory
Initial Documentation and Patient Consents
Case Management:
Clinical Impression
Modes of Care
Frequency of Care
Reassessment
Record Keeping
Outcomes:
Outcome Assessment
Collaborative Care
Management of Complications
Maintenance, Prevention and Supportive Care
Professional Development
The conference participants are comprised of 30 chiropractors, 10 each from private practice, research, and chiropractic institutions. The 30 members represent, as much as possible, the demographic make-up of the chiropractic profession, (i.e. number of years in practice, sex, geographic distribution, education, and practice backgrounds, etc.)
Every member of the chiropractic profession is invited to supply input to the conference participants. Your thoughts, concerns, and suggestions are encouraged in writing to any and all participants. The names and addresses of the conference members are:
Alan Adams, D.C.
16200 East Amber Valley Drive
Whittier, CA 90609
Meredith H. Bakke, D.C.
312 East North Street
De Forest, WI 53532-1258
Linda Bowers, D.C.
2501 West 84th Street
Bloomington, MN 55431-1602
Gerard Clum, D.C.
P.O. Box 367
San Lorenzo, CA 94580
Tammy DeKoekkoek, D.C.
4902 Irvine Center Drive #102
Irvine, CA 92714
Arlan W. Fuhr, D.C.
3714 East Indian School Road
Phoenix, AZ 86060
R. James Gregg, D.C.
1647 Inkster
Garden City, MI 48135-3008
Daniel Hansen, D.C.
1115 Black Lake Blvd. SW Suite A
Olympia, WA 98502
Donald Henderson, D.C.
1494 Islington Avenue
Islington, Ontario
Canada, M9A 3L5
John Hsieh, M.S., R.P.T., D.C.
233 North Milton Drive
San Gabriel, CA 91775-2818
Donald Kern, D.C.
1000 Brady Street
Davenport, IA 52803
Norman Kettner, D.C.
P.O. Box 1065
Chesterfield, MO 63006-1065
Charles Lantz, D.C., Ph.D.
P.O. Box 367
San Lorenzo, CA 94580
John Martin, D.C.
4029 Capital of Texas Hwy S 111
Austin, TX 78704
Dale Mierau, B.B.P.E., D.C., M.Sc., F.C.C.S.C.
5 - 3110 8th Street East
Saskatoon, Sask., Canada S7H 0W2
Marion McGregor, M.Sc., D.C.
200 East Roosevelt Road
Lombard, IL 60148
William Meeker, D.C., M.P.H.
1095 Dunford Way
Sunnyvale, CA 94087
Silvano Mior, D.C., F.C.C.S.(c)
1900 Bayview Avenue
Toronto, Ontario
Canada, M4G 3E6
Robert Mootz, D.C., Ph.D.
1095 Dunford Way
Sunnyvale, CA 94087
Michael Pedigo, D.C.
144 Joaquin Avenue
San Leandro, CA 94577-4708
Kelli Pearson, D.C.
2119 South Tekoa Street
Spokane, WA 99204
Reed Phillips, D.C., Ph.D.
16200 East Amber Valley Drive
Whittier, CA 90609
Dennis Skogsbergh, D.C.
200 East Roosevelt Road
Lombard, IL 60148
Marilyn Smith, D.C.
577 Orange Avenue
Coronado, CA 92118-1826
Monica Smith, D.C.
501 North 16th Street
Belleville, IL 62220-3119
Louis Sportelli, D.C.
175 Deleware Avenue
Palmerton, PA 18071
Neil Stern, D.C.
3804 Yacht Club Drive
Arlington, TX 76016-2560
John Triano, M.A., D.C.
200 East Roosevelt Road
Lombard, IL 60148
Howard Vernon, D.C., F.C.C.D.(c)
1900 Bayview Avenue
Toronto, Ontario
Canada, M4G 3E6
James Winterstein, D.C.
200 East Roosevelt Road
Lombard, IL 60148
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