Professional Success: Measuring Outcomes, Not Incomes

By Robert D. Jansen, PhD

A few short years ago, on my first day at the job as research director at a chiropractic college, I was shown the x-ray department at the student clinic. I naively asked, "But, how do you get the patient to stand in exactly the same position after treatment?" The clinic director looked puzzled. "Why would you want to do that?" he asked. When I learned that only patient billing information was in the college clinic computer, that no clinical outcome measures were taken or kept on patients, it was my turn to ask why.

"There's no need, we already know it works," the clinic director explained.

"We already know what works?" I asked.

"Chiropractic," I was told.

I was baffled by this. Does it make sense to say an entire discipline "works?" In all my years as a psychologist, although people were always investigating how and when specific psychological methods did or did not work, I had never heard anyone say that psychology "worked." Would it make any sense at all to say that botany, anthropology or biology "works?"

Moreover, it seemed to me that even if we could determine that something did "work," by itself, that wasn't saying much. After all, if you want to go from one city to another, flying, driving, walking, and even crawling on your hands and knees, all "work" to get you there. Candles work. Rowboats work. A horse and buggy works.

There is a sign posted on the wall of the linear accelerator at Stanford University which says, "If it works, it's obsolete." In health care, we could paraphrase that to say. "If it works at all, we are ethically bound to try to make it better." For the sake of our patients, our goal must be the continual improvement of chiropractic care.

From its inception, the Consortium for Chiropractic Research has been actively involved in the development of new and valid outcome assessment measures and instruments to determine not just that "chiropractic works," but exactly what kind of patient, exactly when, and exactly how; and, perhaps even more important, exactly when a specific chiropractic technique does not work on a specific type of patient, and why.

During the past five years, as a part of the ongoing low back pain project sponsored by the California Chiropractic Association, the consortium has also employed two widely-used standardized outcome assessment instruments, the Oswestry Scale, and the McGill Pain Questionnaire, in two large-scale studies of patient characteristics in all the West Coast college clinics, and in ten matched field doctors' offices in the same areas as the clinics. The four articles describing this work are being published in the Journal of Manipulative and Physiological Therapeutics.

As a continuation of this CCA project, we are currently in the process of investigating the possibility of the consortium colleges' participation in one of the national outcomes assessment systems, e.g., Interstudy, Quality Quest, Inc., etc. Such national systems have developed standardized, validated and highly reliable modular outcome assessment instruments (paper and pencil forms) for most every diagnostic entity and disease. By selecting the appropriate subset of prevalidated forms (and possibly by adding items and forms we create specifically for chiropractic) we can create a battery custom-designed for chiropractic outcomes assessment. Our plan is to then introduce the use of this consortium outcomes battery to all the college clinics. This will make research of all sorts possible, including comparisons with other health care providers, because these same outcome assessment forms will be routinely used by dozens of different kinds of providers, in thousands of locations across the country.

At the recent (and I believe, historic) Consensus Conference on the Validation of Chiropractic in Seattle, though many reasons to develop and/or use valid and reliable standardized outcome measures were described, one good reason was not mentioned. I am indebted to Dr. Kevin McCarthy of Palmer-West for pointing out that the installation of validated, standardized outcome assessment batteries would fill a vacuum in the college clinic and in the student-clinician, which might otherwise be filled with ideosyncratic, untested, unreliable, or invalid outcome assessments unacceptable to other health care providers or to third-party payers. It is within this framework particularly that standardized, validated, reliable outcome assessments are critically needed.

If you would like to join with the California Chiropractic Association in supporting the consortium's effort to develop and make available a standardized and validated chiropractic outcomes assessment battery, you may become an individual member of the consortium for $65 (sixty-five dollars) per year, which includes the consortium newsletter. Of course, you may also donate any amount in excess of this. Call 800-327-2289 and use your Mastercard or Visa, or send your check to: (Pacific) Consortium for Chiropractic Research, 1095 Dunford Way, Sunnyvale, California 94087.

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