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Wednesday, May 31, 2017

How Is the Clinical Compass Valuable to Your Practice?

William Doggett, DC, FACO, FICC

The mission of the Clinical Compass is to provide consistent and widely adopted chiropractic practice information and to perpetually distribute and update this data as necessary so that consumers and others have reliable information on which to base informed healthcare decisions. 

It is also charged with examining—with a chiropractic lens—all existing guidelines, parameters, protocols and best practices in the United States and other nations. Efforts have been made to make participation and process in these initiatives as transparent as possible and for participants to represent a diverse cross section of the profession.

Origins
Clinical Compass was formed in 1995 and initially named the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) at the behest of the Congress of Chiropractic State Associations (COCSA) and with assistance from the American Chiropractic Association, the Association of Chiropractic Colleges, the Council on Chiropractic Education, the Federation of Chiropractic Licensing Boards, the Foundation for the Advancement of Chiropractic Sciences, the Foundation for Chiropractic Education and Research, the International Chiropractors Association, the National Association of Chiropractic Attorneys (NACA) and the National Institute for Chiropractic Research.

Clinical Compass has a steering organization comprised of 21 individuals. Six members were appointed by COCSA and additional members were appointed by the other founding organizations—16 are chiropractors, with one in education, one in research and 14 in full-time private practice. There is also a vendor representative, a chiropractic college representative, NACA attorney representatives, as well as a public member. A research commission with several dozen members reports to and is supervised by Clinical Compass members.

Literature Synthesis
Clinical Compass researches and rates evidence, which is compiled in a summary document for the chiropractic profession and other related stakeholders. The information contained in the eight clinical chapters covered in this project, assembled by Clinical Compass, is known as a literature synthesis. A literature synthesis is an academically rigorous analysis of all the available scientific literature on a specific topic. Reviewers use internationally accepted tools to rate each article according to specific criteria. These include:

  • type of study (randomized controlled trial, case series, etc.)
  • quality of the study
  • size of the study
  • and many other factors that influence the credibility and strength of the study’s conclusions.

Each reviewer independently rates all the available articles, and the ratings are compared among the members of the review team.

Reaching Consensus
If there is disagreement regarding the conclusions, a formal consensus process is followed to arrive at an overall conclusion with which all reviewers can agree. The resulting conclusions do not represent the reviewers’ own beliefs but rather what the literature actually supports. A literature synthesis is a starting point. It indicates only what we can conclude with supportable scientific evidence. Appropriate therapeutic approaches will consider the literature synthesis as well as clinical experience, coupled with patient preferences, in determining the most appropriate course of care for a patient.        

After Clinical Compass teams with specific skills review and rate all information gathered from multiple databases (synthesis), the information is then translated into easily usable tools. The synthesis is merely evidence stratification for the most common conditions seen by chiropractic doctors. Clinical Compass recognizes that information in this format is difficult to digest and implement. To assist comprehension and ease of application, the synthesis is translated for use in the treatment room via a DIER (Dissemination, Implementation, Evaluation, and Revision). This process will ultimately produce the Chiropractic Clinical Compass©. In addition, in today’s ever-changing healthcare environment, the literature synthesis can be used for many purposes, and Clinical Compass is flexible and responsive to rapidly changing trends and needs.

How Is This Valuable to You?
There was previously a chiropractic malpractice case heard in the South Carolina Circuit Court in Georgetown County; in the case, which involved the treatment of a patient who experienced an acute exacerbation of an injury suffered in a motor vehicle accident 15 years prior, the insurance company sued the treating chiropractor. The insurance company’s position, as stated by the chiropractic witness they hired, was that the patient had been treated in excess of professional standards and should have been referred to a different, non-chiropractic provider after just two to four visits. They contended that the failure to refer the patient at that early time was a violation of practice standards by the treating chiropractor, and thus malpractice. That opinion was based on the absence of specific or significant improvement in the patient’s condition contained in the treatment notes. 

The defense hired their own chiropractic expert witness who reviewed the treatment notes and treatment schedule and then used the acute care algorithm developed by the Clinical Compass, published in the
Journal of Manipulative Physiological Therapeutics in 2015. The defense expert witness explained to the jury that these guidelines were developed for the treatment of acute back pain and were considered professional standards. The jury took less than one hour to decide that the treatment was indeed within professional standards and that there had been no malpractice by excessive treatment.

When Clinical Compass was created by COSCA, many in the profession feared that this was going to be just another guideline to be used by the insurance industry—as they had used the Mercy Guidelines—to limit and restrict chiropractic practice. Now, the validity and relevance of Clinical Compass documents have been upheld in a court of law and demonstrate that the hard work of Clinical Compass members is valuable to all chiropractors who treat patients suffering from injury or disease.

You can access the Clinical Compass chapters online at
www.clinicalcompass.org (under the resources tab drop down to clinical guidelines). While you’re on the site, look into the topics under the Rapid Resource Response Center, R3C. There is valuable information there that can benefit doctors in the field regarding the standards of treating many conditions. One tab over in the drop down menu is the donation tab. The work that the members of Clinical Compass do is funded by donations from state and national chiropractic associations and individuals such as you. Consider making a donation, or ask your state association to donate so that Clinical Compass can continue to inform and protect DCs as it has since 1995.

Dr. Doggett serves as a COCSA representative on the Clinical Compass steering committee. 


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