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CCGPP Clinical Compass Update

CCGPP Clinical Compass Update. COCSA St. Petersburg 11/14/2009. CCGPP Mission.

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CCGPP Clinical Compass Update

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  1. CCGPP Clinical Compass Update COCSA St. Petersburg 11/14/2009

  2. CCGPP Mission • It is the mission of the CCGPP to provide accountable and representative leadership for the development, evaluation and dissemination of clinical practice guidelines and parameters for quality health-care improvement.

  3. To promotethe improvement of the quality of chiropractic services and of the professional reputation of doctors of chiropractic • To promote the intellectual, academic, and clinical integrity of chiropractic practice • To promote the intellectual, academic, and clinical integrity of practice guidelines and practice parameters developed for the chiropractic profession

  4. Literature Syntheses JMPT Publications

  5. November/December ’08 and January ’09 Issues

  6. Chiropractic Management of Low Back Pain and Low Back Related Leg Complaints: A Literature Synthesis • Chiropractic Management of Low Back Disorders: Report from A Consensus Process • Chiropractic Management of Myofascial Trigger Points and MyofascialPain Syndrome: A Systematic Review of the Literature • Chiropractic Management of Fibromyalgia Syndrome: A Systematic Review of the Literature • Chiropractic Management of Tendinopathy: A Literature Synthesis • Manipulative Therapy for Lower Extremity Conditions: Expansion of Literature Review

  7. Thoracic Chapter • Completed and preparing for publication

  8. Subluxation Chapter • Collaborating with the ACC Subluxation Task Force • In process

  9. Reports Neck Conditions and Diagnostic Imaging

  10. One of the chief criticisms of the Neck Conditions and Diagnostic Imaging reports is that these reports did not perform original literature syntheses, but instead evaluated and endorsed recently published guidelines on their respective topics. • Evaluation of existing guidelines has from the beginning of the Commission’s efforts been a recognized part of the CCGPP mandate. • In the case of these two topics, guidelines happened to be published based on the pertinent literature that our teams were still involved in collecting and evaluating.

  11. As these new guidelines were written with DC input, the Commission felt that it would be redundant to continue a process which other (and much better funded) groups had already completed based on the very same body of literature. • Thus, these two teams were asked to complete a “report” rather than a “chapter,” which would describe their assessment of the guidelines and rate them using the AGREE instrument.

  12. The other major criticism is that these reports did not cover all the important clinical issues that were outside the scope of the guidelines they endorsed. • The CCGPP Agrees with this criticism! • However, it is beyond our current resources, both financial and human, to accomplish the necessary additional literature searches and analyses. • These will have to be postponed until the CCGPP secures the requisite funding for the next iteration.

  13. DIER Projects Dissemination, Implementation, Evaluation and Review (DIER) Projects

  14. Chiropractic Management of Fibromyalgia Syndrome: A Systematic Review of the Literature • Fibromyalgia is often treated with conservative nonpharmacologic modalities. • A recent extensive literature review by Schneider et al aimed to find out which of them had more evidential support in the literature. • The article was the outcome of a charge by the Scientific Commission of the CCGPP to evaluate and report on the evidence base for chiropractic care. * Surgical Neurology 72 (2009) 4-5

  15. Extensive reviews of the literature are of course not the same as original research. • However, when original research is limited, published in disparate sources, and information is not widely distributed, such reviews can be valuable.

  16. Continuing Education • Evidence-based Documentation and Case Management of Patient Centered Care Webinar • Cosponsored by Northwestern Health Sciences University • Presented by Dr. Wayne Bennett

  17. Physical Medicine Research Institute (PMRI) • Considering a retrospective Workers Compensation claim review of the California Workers Compensation Insurance (CWCI) database • Utilize Chiropractic Management of Low Back Disorders: Report from a Consensus Process as adopted by the Occupational Disability Guidelines (ODG) • Allowing an initial round of acute care of up to 12 visits.  If progress is being made, an additional round up to another 12 visits is recommended for a total of 24 visits. • That increase represents a 25% increase over ODG’s prior recommendations of only 18 visits. 

  18. Consensus Projects CCGPP

  19. Definitions of Care Levels: A Consensus Report • ACA’s Insurance and Managed Care Committee has been aware for some time that third-party payers misinterpret ACA’s current definitions for supportive and maintenance care to the detriment of patients

  20. To this end, ACA engaged the CCGPP, which undertook the scientific, multi-disciplinary study that resulted in the new definitions. • Adopted by the ACA House of Delegates in September 2009. * ACA News November 2009

  21. Chronic/Recurrent Care • New consensus project currently in progress • Multidisciplinary • Will identify indicationsand contraindications for chiropractic management of chronic/recurrent conditions. • Will identify appropriate documentation.

  22. FCLB Federation of Chiropractic Licensing Boards

  23. Best practices address the issues beyond minimum standards and encourage excellence in practice • Should provide information for regulatory boards to not only protect the public, but to also promote better care, to the advantage of all who utilize chiropractic or are impacted by our profession in any manner • Best practices should aid agencies in addressing complaints where there is no violation of regulations or scope of practice, yet less than optimal care was delivered

  24. Best Practices are NOT a standard, unless they are adopted as a regulation!

  25. Chiropractic Summit CCGPP Participates

  26. Dr. Ron Farabaugh, CCGPP Vice Chair, has been a valued contributor

  27. NGC National Guidelines Clearinghouse

  28. Published chapters have been submitted for consideration of inclusion • Currently “in process”

  29. Rapid Response Team Responses 2007 to Present

  30. The Rapid Response Team (RRT) will serve as a resource for field DCs or organizations in terms of reviewing complaints concerning the possible misuse of evidence.

  31. Future CCGPP

  32. Ongoing DIER projects • GAP analysis • Rapid Response Team interventions • Revision preparation

  33. Change is inevitable, growth is optional!

  34. Thanks! Questions?

  35. CCGPP PO Box 2054 Lexington, SC 29071 www.ccgpp.org

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