This section is compiled by Frank M. Painter, D.C. Send all comments or additions to:
Frankp@chiro.org
The intention of this page is to inform our profession about information reporting standards within the Third Party (Insurance) arena. The future of regulated health care will be “accountability”. Doctors are required to document patient complaints, exam findings, their conclusions, diagnoses, and patient progress. Patient “care plans” will need to be driven by those findings. You may also refer to the Outcome Assessment Section and the Documentation Section for more information.
Chiro.Org is proud to support the FCER and the ICPA and their continuing research into the health benefits of chiropractic care. Please offer them your financial assistance!
Articles about Guidelines
Rigorous Development Does Not Ensure That Guidelines are Acceptable to a Panel of Knowledgeable Providers
J Gen Intern Med 2007 (Nov 21) [Epub ahead of print]
Despite very rigorous development methods compared with guidelines assessed in prior studies, experts felt that these guidelines omitted common clinical situations and contained much content of uncertain validity. Guideline acceptability should be independently and formally evaluated before dissemination.
Clinical Practice Guidelines: The Dangerous Pitfalls of Avoiding Methodological Rigor
Journal of the Canadian Chiropractic Assoc 2001 (Sep); 45 (3): 141-153
Clinical practice guidelines developed by the Canadian Chiropractic Association (CCA) and the Council on Chiropractic Practice (CCP) were evaluated by three independent appraisers using the most current version of the Appraisal of Guidelines for Research and Evaluation in Europe (AGREE) Instrument. The strengths of both documents include clarity of objectives and target users and complete descriptions of methods used to formulate recommendations. Areas of improvement for both documents include the need for more detail regarding the bodies of evidence under consideration for each section of the guideline. This paper presents the complete results of the evaluation, discusses the strengths of each guideline document, and makes suggestions for areas of
improvement.
Evaluation of Clinical Practice Guidelines in Chiropractic Care: A Comparison of North American Guideline Reports
Journal of the Canadian Chiropractic Assoc 2001 (Sep); 45 (3):
In the past two decades, clinical guidelines have become practical tools that assist clinicians, policy makers and insurers make informed decisions about the clinical and administrative management of patients. The popularity of these tools has increased so rapidly that clinicians now face the dilemma of having to choose from a plethora of documents of varying quality that were developed by various scientific, professional, political and commercial parties. In this context, a key challenge for the users of clinical practice guidelines is to determine whether their recommendations are valid, useful, based on the best available evidence and developed with sound scientific methodology.
Evaluation of Clinical Practice Guidelines in Chiropractic Care: A Comparison of North American Guideline Reports
JCCA 2001 (Sep); 45 (3): 141–153 ~ Adobe Acrobat (234 KB)
Clinical practice guidelines developed by the Canadian Chiropractic Association (CCA) and the Council on Chiropractic Practice (CCP) were evaluated by three independent appraisers using the most current version of the Appraisal of Guidelines for Research and Evaluation in Europe (AGREE) Instrument.
Evidence-based Clinical Guidelines Submitted to the Australian National Health and Medical Research Council for the Management of Acute Low Back Pain: A Critical Review
J Manipulative Physiol Ther 2001 (Feb); 24 (2): 131–139 ~ FULL TEXT
Moves are afoot in Australia to publish Evidence-Based Clinical Guidelines for the Management of Acute Low Back Pain.1 A draft has been prepared by Professor Nikolai Bogduk of the University of Newcastle and the Newcastle Bone and Joint Institute, New South Wales. Bogduk has made a gallant attempt to address the issue of acute low back pain, but the document is seriously flawed in many respects. This is surprising and alarming, given the author's prominence in the international spine community. You might also want to read additional comments on this document made by Anthony L. Rosner, PhD, research director for FCER.
Evaluating the Quality of Clinical Practice Guidelines
J Manipulative Physiol Ther 2001 (Mar); 24 (3): 170–176
The literature reviewed suggests that professional organizations or groups should undertake a critical review of guidelines using available critical guideline appraisal tools. Guideline validity appraisal should be done before acceptance by the chiropractic profession. To avoid unwarranted utilization of poorly constructed guidelines, it is strongly recommended that all future guidelines be reviewed for validity and scientific accuracy with the findings published in a medically indexed journal before they are adopted by the chiropractic community.
Developing Clinical Guidelines
British Medical Journal 1999 (Feb 27); 318: 593–596 ~ FULL TEXT
The methods of guideline development should ensure that treating patients according to the guidelines will achieve the outcomes that are desired. This article presents a combination of the literature about guideline development and the results of our combined experience in guideline development in North America and Britain. It considers the five steps in the initial development of an evidence based guideline
Chiropractic Care for Common Industrial Low Back Conditions
Chiropractic Technique 1993 (Aug); 5 (3): 119–125 ~ FULL TEXT
This is the first guideline I have seen which actually states the number of visits which may be appropriate for a variety of common low back conditions. I have used these "care
plans" for years, presenting them to third party's as a "working diagnosis" care plan, which need ongoing "fine tuning" during patient care. Check out this Chiropractic Technique article, and the attached care plans, which have been released exclusively to Chiro.Org by the National College of Chiropractic. Thanks, Dana! You will find other information like this in the GUIDELINES Section.
as Adobe Acrobat (PDF) Format
They are formatted, so you can add your own letterhead and mail them out to claim adjusters tomorrow! Just use “save-as” and they are all yours!
Alternative Medicine Guidelines
Britain's Department of Health, in collaboration with the Foundation for Integrated Medicine has published Complementary Medicine, a document that explains the benefits of the top six complementary therapies provided by Britain's National Health Service (NHS).
Best Practice Initiative
Review the various Best Practice documents crafted by the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) and the ICA. You may also enjoy the Evidence-based Practice Page.
Insurance Industry Guidelines
This section defines terminology, outlines "accepted (and unaccepted) diagnostic tests" in Personal Injury, and offers you access to Allstate's "confidential" Employee Training Manual.
Low Back Pain Guidelines from Around the World A new addition is the Danish Institute's Low Back Pain Guidelines, available in HTML or PDF files. This section also includes the 1994 AHCPR guides, the Royal College (2000) recommendations, the "Mercy Document", and the New Zealand
"Psychosocial Yellow Flags" Page
Neck Injury Guidelines New additions include 6 tables from Art Croft DC's Whiplash Injuries: The Cervical Acceleration/ Deceleration Syndrome which contain information on complicating factors for recovery, guidelines for frequency and duration of care, treatment adjuncts and contraindications to manipulation. It also includes guidelines from the California Industrial Medical Council. You may also want to view the Whiplash Page.
Pran Manga Guidelines
Includes the original 1993 and the updated 1998 recommendations to the Canadian Government about inclusion of chiropractic in their Health Care System.
Subluxation–based Guidelines
Includes Guidelines from the International Chiropractors Association (ICA) and the Council on Chiropractic Practice (CCP) regarding Instrumentation, Radiographic and other Imaging, Clinical Impression and Assessment, Reassessment and Outcome Assessment, Modes of Adjustive Care, Duration of Care for Correction of Vertebral Subluxation, and Chiropractic Care for Children.
AHCPR Guidelines Access
The original Agency for Health Care Policy and Research (AHCPR) has now evolved into Agency for Healthcare Quality and Research (AHRQ).
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