Ronald J. Farabaugh, DC
Rumor has it that the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) is developing a new guideline. I say "rumor," because like all rumors, the information released so far has been filled with a combination of fact, fiction and, at times, outright misinformation. I intend to produce a series of short articles over the next six months explaining the facts in an effort to help the chiropractic profession understand the process and the differences between a "Best Practice" initiative and a "guideline."
Who Are the Players?
Congress of Chiropractic State Associations (COCSA): COCSA was formed in the late 1960s and is a non-profit organization consisting of state chiropractic associations. The mission of COCSA is to provide an apolitical forum for the promotion and advancement of the chiropractic profession through service to member state associations.
COCSA is comprised of nearly all chiropractic state associations and is divided into five districts. It was originally formed to give associations a forum to exchange ideas and develop solutions to common problems. The annual convention has turned into one of the premier chiropractic events of the year, attracting profession leaders from every corner of the chiropractic philosophical, scientific, legislative/legal, and corporate spectrums. COCSA also has its own Web site (www.cocsa.org).
Council on Chiropractic Guidelines and Practice Parameters (CCGPP): CCGPP was formed in 1995 at the behest of COCSA to address ongoing guideline development and refinement. Eventually, the committee decided upon a Best Practice initiative. The process for committee selection has been open and as transparent as possible.
The goal of CCGPP was to represent a diverse cross-section of our profession by offering different points of view. Five members of CCGPP were appointed by the representative national COCSA districts, with one at-large COCSA representative. Other members were chosen or appointed by professional organizations, including the American Chiropractic Association; Association of Chiropractic Colleges; Council on Chiropractic Education; Federation of Chiropractic Licensing Boards; Foundation for Chiropractic Education and Research; International Chiropractors Association; National Association of Chiropractic Attorneys; Foundation for the Advancement of Chiropractic Tenets and Science (FACTS); and the National Institute for Chiropractic Research. The CCGPP is a steering organization comprised of 20 chiropractors, with one in education, one in research, and one vendor representative. About 18 of the 20 chiropractors are in full-time private practice. The CCGPP also has a Web site (www.ccgpp.org).
The "Commission": This committee, a group of well-known scientists and academicians within our profession, many of whom come from our colleges, was appointed by and serves at the request of CCGPP. This body is actually gathering, rating and summarizing the research and producing the final Best Practice document. Members of the Commission include well-known individuals, including Drs. John Triano, William Meeker, Cheryl Hawk, Alan Adams, Donald Murphy, Robert Mootz and Warren Hammer, and many others. Over 50 scientists and academicians are working on this massive project. Although involvement is rather dynamic, the workgroups involved with the project are divided as follows (leaders of the sections in the Best Practices document are in bold):
Introduction: Dr. Jay Triano, Dr. Alan Adams, Dr. Eugene Lewis;
Neck-Related Disorders: Dr. Don Murphy, Dr. Jerry Grod, Dr. Gary Tarola, Dr. Larry Wyatt, Dr. Paul Dougherty, Dr. Michael Freeman;
Thoracic-Related Disorders: Dr. Jay Triano, Dr. Mark Erwin, Dr. Bruce Symons, Dr. Norman Kettner, Dr. Brian Justice, Dr. Randall Adams;
Low Back-Related Disorders: Dr. Bill Meeker, Dr. Dana Lawrence, Dr. Marc Micozzi, Dr. Jeffrey Cates, Dr. Bart Green, Marsha Handel, Dr. Gert Bronfort, Dr. Robert Mootz;
Upper Extremity Disorders: Dr. Thomas Souza, Dr. Susan Holm, Dr. Dale Buchberger, Dr. Ed Feinberg, Dr. Michael Carnes, Dr. Joe Horrigan;
Lower Extremity Disorders: Dr. Stephen Perle, Dr. Keith Jeffers, Dr. James Brantingham, Dr. John Scaringe, Dr. Thomas Michaud, Dr. Bill Moreau;
Soft-Tissue Conditions: Dr. Max Lawson, Dr. Warren Hammer, Dr. Kim Ross, Dr. Gordon Ko, Dr. Tom Hyde, Dr. Veronica Sciotti, Dr. Mark Pfefer;
Wellness and Non-Musculoskeletal Disorders: Dr. Cheryl Hawk, Dr. Jacqueline Bougie, Dr. John Hyland, Dr. Randy Ferrance, Dr. Ashley Cleveland, Dr. Meridel Gatterman. Dr. Thomas Davis.
In simplest terms, the commission is writing the document, while the CCGPP is monitoring, reviewing, and generating the financing to complete the documentation process. Members of the CCGPP will gladly travel to your state to present information and answer questions. Simply call (803) 808-0640 if you are interested in a presentation. Since funds are limited, all we ask is for your organization to cover our travel expenses. Our time is donated to your association.
Work Loss Data Institute (WLDI): CCGPP contracted with WLDI to publish and distribute the final document. WLDI was chosen because of its wide experience in this area and its ability to get this type of document into many hands. Once completed, the Best Practices document will be distributed to the profession, third-party payors and governmental agencies. WLDI is a company in the business of developing and publishing for a wide range of health care organizations. WLDI also publishes the Official Disability Guidelines (ODG), a guideline that does not adequately represent chiropractic Best Practices to this point. WLDI plans on integrating the new Best Practice chiropractic document and information into ODG to improve the recommendations pertaining to chiropractic management. WLDI's Web site is www.worklossdata.com.
What's the Difference Between "Guideline" and "Best Practice"?
In short, a guideline contains numbers and/or suggested therapy time frames that are often mistakenly applied as arbitrary limits. Best Practice is a process/document that reviews the evidence and provides interpretation consistent with the chiropractic perspective as the providers involved in treating these cases, using chiropractic methods. Best Practice is more of an ongoing dynamic process and initiative rather than just a document.
The Best Practice initiative contains three elements: research, clinical judgment, and patient values. Consider these short definitions:
Best Practices is a "criteria document," designed for clinical decision-making according to evidence-based research. However, it is also outcome based encouraging innovation for the future of health care delivery. - Allen Unruh, DC (CCGPP Board Member)
Best Practices are clinical judgments regarding patient care that are informed by the best evidence and balanced by patient complexity and provider experience to improve the quality and reduce the costs of care. - John Triano, DC, PhD (Commission Co-Chair)
Chiropractic Best Practices bring the chiropractic "philosopher/healer," the "skeptic/researcher," and the "pragmatist/practitioner" together on common ground to meet the needs of the chiropractic patient in the best possible manner. - Wayne Bennett, DC (CCGPP Board Member)
The focus is on the process of care, identification of risk factors and case complexity, techniques of response monitoring, and benchmarks for intervening when the response is below average.
Hopefully, this article helps clarify some of the mystery concerning the effort of CCGPP to produce a Best Practices document. This process is open, accessible, and is nothing to fear. In fact, Best Practice will open doors, clarify treatment issues, and provide the chiropractic and allopathic communities - and the patients we serve - a wealth of information concerning what works best according to the literature. In the end, our goal is to improve patient care - period.
Over the next six months, we will continue to release detailed information in response to the most common questions and answers pertaining to this historic initiative. Based upon the literature produced to date, we strongly feel that what we do daily in our profession will continue to be ever-increasingly supported by evidence.
My next article will focus on the benefits of the Best Practice initiative to you and/or your state association and our patients. I will also address some of the most commonly asked questions, including, "What is evidence-based care?" In the meantime, feel free to e-mail me at the address below with any questions or concerns.
Ronald J. Farabaugh, DC
Columbus, Ohio
chironf@aol.com
