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Dynamic Chiropractic – January 1, 2006, Vol. 24, Issue 01
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Dynamic Chiropractic

CCGPP's Best Practices Document: Stakeholder Review

By Mark D. Dehen, DC

The Council on Chiropractic Guidelines and Practice Parameters (CCGPP) is pleased to announce that in early February 2006, we will be releasing the initial draft of the Low Back best practice document for review and comment by stakeholders - including the public.

This highly anticipated document is the first chapter of what will become the Chiropractic Clinical Compass, a chiropractic review of the current literature designed to enhance outcomes for individual patients.

The Low Back document will be available at www.ccgpp.org for review and comment for 60 days from its initial release date. Subsequent chapters will then follow for your review. The CCGPP encourages any and all interested parties to invest the time to comment on this work. The scientific validation criteria (e.g., the AGREE document) guiding the CCGPP requires broad stakeholder review before final release. In this case, "stakeholders" include doctors of chiropractic, patients, students, educators, third-party payers, governmental entities, and all other interested parties.

Each chapter is being researched and written by a team of chiropractors and scientists based on an extensive review of the literature, including materials submitted by stakeholders. This work is an iterative process, and the initial scope will focus on the most common disorders and clinical approaches used by the doctor of chiropractic. Articles continue to be collected via a number of sophisticated search vehicles with the help of various chiropractic educational facility librarians, as well as from field practitioners. Assessment of the literature uses standardized instruments consistent with those recognized by policy-makers and the broader health community. When appropriate, formal consensus processes, modeled after those used by the RAND Corporation in its considerations involving care used by doctors of chiropractic, are being employed. Obviously, this is a more ambitious review than the average field practitioner would have the ability to accomplish, which is the operating premise for the efforts of the CCGPP.

The next step in the process is the all-important public comment period. This is your opportunity to provide your opinion of the work accomplished to date, and to note any additional rational evidence you feel may have been overlooked. At the end of the 60 days, all comments will be harvested, collated and reviewed by the original teams. Any and all amendments to the document (where appropriate), as well as all responses to comments (with rationale for accepting or rejecting a particular point), will be published in the final version. The complete document will then be published in 2007 for distribution throughout the profession and its partners.

The CCGPP looks forward to your comments. This is not the end of the story, however. As part of the DIER (development, implementation, evaluation and revision) process being utilized, upon completion of the development process, implementation begins. Implementation will entail the offer of training, both profession-wide and for all stakeholders, with the assistance of the educational institutions and state associations. This training will be directed at proper interpretation, translation and utilization in specific patient encounters. The CCGPP, as it continues the iterative process over time, will stand ready to respond and clarify the best practices results in an effort to minimize inappropriate use and application of the document.

Following that, the entire process will be evaluated for effectiveness in enhancing patient outcomes, which is the principle reason for the Compass. We expect use of the Clinical Chiropractic Compass will improve patient outcomes, forming the basis for the revision process, and the cycle will repeat itself. The knowledge we gain from the process will be combined with advances in the chiropractic and other evidence-based literature. Hopefully, this will provide for continuing ongoing enhancement of what chiropractic is all about: helping our patients.

Mark D. Dehen, DC
Vice chairman, Council on Chiropractic Guidelines and Practice Parameters

Editor's note: In the past year, Dynamic Chiropractic has published a series of articles on the CCGPP's ongoing best practice initiative. For more information, visit www.chiroweb.com and type "best practice" in the search box on the top left of the page.

Dr. Mark D. Dehen is a second-generation doctor of chiropractic practicing in North Mankato, Minn., where he does ergonomic consulting and injury prevention for local industries. Dr. Dehen is a past president of the Minnesota Chiropractic Association and the immediate past chair of the CCGPP.

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