Accepted Guidelines:
The most credible treatment guideline in existence today that pertains
to Chiropractic healthcare is "Mercy". However, Mercy was written
in 1992 and a wealth of quality research has been performed and reported
since Mercy was published. An exciting new document is being developed
(due for release in 2007) by the Council on Chiropractic Guidelines
and Practice Parameters (CCGPP) that focuses on "Best Practices" vs.
"Guidelines". As most clinicians have discovered, guidelines can be
horribly misused and abuse by consultants and claims/case managers
who do not seem to understand their limitations. Guidelines serve
as background information upon which to glean an "ideal" starting
point for review. Guidelines should not be used as cookbooks or prescriptions
for care, and should not be used to deny care as a sole reason for
the denial. Many ill-informed or disingenuous consultants rely on
just the research and fail to understand that "Best Practice Initiatives"
include three integral components; (1) research, (2) clinical decision
making, and (3) patient values.
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What is the
difference between "guideline" and "best practice"?
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In short, a guideline contains numbers/suggested
therapy time frames that are often mistakenly applied as arbitrary
limits. Best Practice (BP) 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 (Triano).
BP 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/explanations:
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, D.C. (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, D.C., Ph.D. (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,
D.C. (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. |
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