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CCGPP's Best Practices 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 Best Practices Low Back document for review and comment by stakeholders, including the public. This is the culmination of 10 years of process and two years of diligent effort by nearly 100 chiropractic scientists, field practitioners, vendors and friends. This highly anticipated document is the first chapter of what will become the Best Practices Chiropractic Clinical Compass, providing a chiropractic review of the current literature in an effort to enhance outcomes for our individual patients.

The Low Back document will be available at for review and comment for 60 days from its initial release. 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 validity criteria (e.g. AGREE document) process guiding the CCGPP requires broad stakeholder review before final release. In this case stakeholders include Doctors of Chiropractic, patients, students and 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 most common clinical approaches used by the Doctor of Chiropractic. Articles were and are being collected via a number of sophisticated search vehicles with the help of various chiropractic educational facility librarians, as well as from field practioners. Assessment of the literature uses standardized instruments consistent with those recognized by policy makers and the broader health community. Where appropriate formal consensus processes, modeled after those used by the Rand Corporation in their 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 and is the 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 done to date and any additional rationale 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.

This, however, is not the end of the story. As part of the Development, Implementation, Evaluation and Revision (DIER) 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. 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 Best Practices 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, and hopefully provide for continuing ongoing enhancement of what chiropractic is all about: helping our patients.

Dr. Mark D. Dehen is a second generation Doctor of Chiropractic practicing in North Mankato, MN. He does ergonomic consulting and injury prevention for local industries. Dr. Dehen is a past president of the MN Chiropractic Association and recipient of the MN Chiropractor of the Year award. Currently, he serves as Vice President of the CCGPP.




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