Two diverse chiropractic care facilities, the Palmer University Chiropractic Clinics, and the chiropractic division of the Texas Back Institute, have both accepted into a national effort to improve the quality of care for low back pain. The program, known as the "Collaborative on Low Back Pain," is sponsored by the Boston-based Institute for Health Care Improvement (IHI). It is part of an ongoing effort to improve quality of care in health care systems, an issue of increasing relevance under managed care.
Several chiropractic organizations have provided grant support for this effort, including the Foundation for Chiropractic Education and Research (FCER), the American Chiropractic Association (ACA), and the Council for Chiropractic Guidelines and Practice Parameters.
The "Collaborative on Low Back Pain" is a year-long effort chaired by Richard Deyo, MD, well-known back pain researcher. This program focuses on bringing the science surrounding care of low back problems and the clinical practice closer together. The IHI approach to quality improvement centers around "instituting and measuring the effects of small changes within large systems." A number of large corporations, medical centers, and insurers are participating in the effort, including: General Motors; the Mayo Clinics; Kaiser; Harvard-Pilgrim Health Plans; and Blue Cross of California.
The IHI faculty is under the direction of Dr. Deyo and includes a broad multidisciplinary range of specialists, including: James Weinstein, DO, editor of the Spine Journal; noted researchers Dan Cherkin, PhD; Robert Mootz, DC; Tim Carey, MD; and Allan Jette, PT, PhD, dean of the physical therapy program at Austin University. The goal of this effort is to increase the use of effective care for people with low back pain while reducing unnecessary or inappropriate care.
Kevin McCarthy, DC, Clay McDonald, DC, and William Meeker, DC, MPH, are the IHI team from Palmer University. Dr. McCarthy sees the project as an opportunity to help the Palmer clinics "implement incremental improvements that can both improve care for our patients, and enhance the practical learning for interns who now face managed care and protocol driven decision making once in practice." Dr. McCarthy expects the Palmer clinics to learn "state-of the-art quality improvement techniques."
IHI faculty member Robert Mootz, DC, an associate medical director of workers' compensation in Washington state, said he was excited to see a chiropractic teaching clinic involved. "No medical schools or medical teaching clinics are participating, making Palmer's presence a unique opportunity," he explained.
In participating in the IHI program, Palmer hopes to develop and implement "critical care pathways and standardization of patient education and exercise protocols for low back patients within the first few weeks of presentation." Dr. McCarthy elaborated: "Our clinics are reorganizing to better incorporate quality improvement efforts, protocols, and guidelines in ways that optimize how we care for our patients and prepare our graduates to face the realities of contemporary health care."
Dr. John Triano heads up the chiropractic division of the Texas Back Institute (TBI) and will be leading the team which includes Daniel Hansen, DC, and TBI practice administrator Lisa Raines. Dr. Triano noted: "This is an important opportunity for the chiropractic profession to showcase the application of the best quality management strategies on two diverse practice styles, each focusing on a different patient case mix."
TBI's chiropractic division has expanded its multidisciplinary role by bringing on two more DCs to meet increasing demand for services. TBI's patients have both direct access to chiropractic care and through physician referral.
TBI has already begun putting together quality improvement teams and sees important benefits to the IHI program. Dr. Triano explained: "Our initiatives will include enhancing the effectiveness of patient triage to 'fast-track' appropriate cases to chiropractic care, as well as monitoring progress of chiropractic care within the multidisciplinary setting. Another outcome will involve the defining of expectations from all of TBI's constituencies." Dr. Mootz, who has been working with the IHI project since January, points to the increased competition for low back pain patients: "For chiropractors to maintain a competitive edge, it will be necessary for us to continually reassess how we are doing and how we compare to other state of the art conservative approaches to back pain care."
