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