COCSA St. Petersburg11/14/2009
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.
To promote the 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
JMPT Publications
November/December ’08 and January ’09 Issues
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 andMyofascial Pain 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
Completed and preparing for publication
Collaborating with the ACC Subluxation Task Force
In process
Neck Conditions and Diagnostic Imaging
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.
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.
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.
Dissemination, Implementation, Evaluation and Review (DIER) Projects
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
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.
Evidence-based Documentation and Case Management of Patient Centered Care Webinar
Cosponsored by Northwestern Health Sciences University
Presented by Dr. Wayne Bennett
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.
CCGPP
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
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
New consensus project currently in progress
Multidisciplinary
Will identify indications and contraindications for chiropractic management of chronic/recurrent conditions.
Will identify appropriate documentation.
Federation of Chiropractic Licensing Boards
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
Best Practices are NOT a standard, unless they are adopted as a regulation!
CCGPP Participates
Dr. Ron Farabaugh, CCGPP Vice Chair, has been a
valued contributor
National Guidelines Clearinghouse
Published chapters have been submitted for consideration of inclusion
Currently “in process”
Responses 2007 to Present
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.
# Organization Project
1ACA
Care Level Definitions Consensus Project
2 Mechanical Devices
3Anthem
Definition of OMT vs. CMT
4BC/BS -OK
Denying payment for ESTIM/experimental
5California Workers Compensation
Low Back guideline development
6 Chronic Care Guideline
7Ohio-CompManagement
Bad consultant misusing ODG
8 Spinal Decompression
9 Anthem-Ohio Discriminatory Policies
# Organization Project
10 Summit/ACA Education Packet11 Generic Responses12 Highmark Maintenance Care13 Humana
14BC/BS
Quoting CCGPP inappropriately
15Milliman and Robertson
Discussed limitation of guidelines
16Medical Board-Chiropractic Coverage
17MUA
Requested to develop guideline
18NCQA
Biomechanical analysis and x-ray
# Organization Project
19 NY-Work Comp Guideline
NY requested help developing WC guideline
20ODG
Work with ODG to update their guidelines
21BC/BS-TN
Met with administrators regarding guidelines
22Travelers
Treatment duration question
23Tufts
Tx for children policy/restrictions
24UHC-2007
Headache and Pediatrics issues
25UHC-2008
Proper use of guidelines/UHC-
26UHC-2009
Chiropractic Services Policy
27 BC/BS-VT Policy issues
CCGPP
Ongoing DIER projects
GAP analysis
Rapid Response Team interventions
Revision preparation
Questions?
PO Box 2054 Lexington, SC 29071 www.ccgpp.org