CCGPP Clinical Compass Update

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CCGPP Clinical Compass Update

• COCSA St. Petersburg
• 11/14/2009

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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.

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• 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

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Literature Syntheses

• JMPT Publications

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• November/December 08 and January 09 Issues

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• 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 Myofascial 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

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Thoracic Chapter

• Completed and preparing for publication

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Subluxation Chapter

• Collaborating with the ACC Subluxation Task Force
• In process

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Reports

• Neck Conditions and Diagnostic Imaging

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• 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 Commissions 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.

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• 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.

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• 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.

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DIER Projects

• Dissemination, Implementation, Evaluation and
  Review (DIER) Projects

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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

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• 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.

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Continuing Education

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

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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
  ODGs prior recommendations of only 18 visits. 

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Consensus Projects

• CCGPP

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Definitions of Care Levels A Consensus Report

• ACAs Insurance and Managed Care Committee has
  been aware for some time that third-party payers
  misinterpret ACAs current definitions for
  supportive and maintenance care to the detriment
  of patients

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• 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

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Chronic/Recurrent Care

• New consensus project currently in progress
• Multidisciplinary
• Will identify indications and contraindications
  for chiropractic management of chronic/recurrent
  conditions.
• Will identify appropriate documentation.

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FCLB

• Federation of Chiropractic Licensing Boards

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• 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

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

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Chiropractic Summit 

• CCGPP Participates

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

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NGC

• National Guidelines Clearinghouse

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• Published chapters have been submitted for
  consideration of inclusion
• Currently in process

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Rapid Response Team

• Responses 2007 to Present

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• 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.

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Organization Project
1 ACA Care Level Definitions Consensus Project
2  Mechanical Devices
3 Anthem Definition of OMT vs. CMT
4 BC/BS -OK Denying payment for ESTIM/experimental
5 California Workers Compensation Low Back guideline development
6 Chronic Care Guideline  
7 Ohio-CompManagement Bad consultant misusing ODG
8 Spinal Decompression
9 Anthem-Ohio  Discriminatory Policies
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Organization Project
10 Summit/ACA Education Packet
11 Generic Responses
12 Highmark Maintenance Care
13 Humana  
14 BC/BS Quoting CCGPP inappropriately
15 Milliman and Robertson Discussed limitation of guidelines
16 Medical Board-Chiropractic Coverage
17 MUA Requested to develop guideline
18 NCQA Biomechanical analysis and x-ray
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Organization Project
19 NY-Work Comp Guideline NY requested help developing WC guideline
20 ODG Work with ODG to update their guidelines
21 BC/BS-TN Met with administrators regarding guidelines
22 Travelers Treatment duration question
23 Tufts Tx for children policy/restrictions
24 UHC-2007 Headache and Pediatrics issues
25 UHC-2008 Proper use of guidelines/UHC-
26 UHC-2009 Chiropractic Services Policy
27 BC/BS-VT Policy issues
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Future

• CCGPP

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

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Change is inevitable, growth is optional!
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Thanks!

• Questions?

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CCGPP

• PO Box 2054
• Lexington, SC 29071 www.ccgpp.org