Council on Chiropractic Guidelines and Practice Parameters Formed

Guidelines Process to Continue under Supervision of Chiropractic Practitioners -- Mercy Revision First Priority

By Editorial Staff

ST. LOUIS, Missouri -- The creation of an organization responsible for overseeing the chiropractic practice guidelines process, the Council on Chiropractic Guidelines and Practice Parameters, was the result of an October 23-24 conference of the Congress of Chiropractic State Associations (COCSA). The panel of 16 DCs represented most of the major organizations in the profession (please see "Guidelines' Development Planning Conference Participants" on page XX).

The Council will be a non-profit corporation (501c3) with the primary task of supervising the development of chiropractic guidelines, which includes deciding which areas in the existing guidelines should be reviewed, and what new areas require practice guidelines.

The Council will have a board of 21 directors to represent the various segments of chiropractic, composed as follows:

Field Chiropractors (12): * Congress of Chiropractic State Associations (COCSA): six board members -- one representative from each of the five districts, and one from the COCSA Executive Board.

American Chiropractic Association (ACA) -- one rep.
International Chiropractors Association (ICA) -- one rep.
Federation of Chiropractic Licensing Boards (FCLB) -- one rep.
"At large" chiropractors (unaffiliated) -- three appointed by the board

Chiropractic Educators (2):

Association of Chiropractic Colleges (ACC) -- one rep.
Council on Chiropractic Education (CCE) -- one rep.

Research Chiropractors (4):

Consortium for Chiropractic Research (CCR) -- one rep.
Foundation for Chiropractic Education and Research (FCER) -- one rep.
Foundation for the Advancement of Chiropractic Tenets and Science (FACTS) -- one rep.
National Institute for Chiropractic Research (NICR) -- one rep.

Public Members (3), chosen by the board:

Chiropractic Vendors -- one rep.
Consumers -- one rep.
National Association of Chiropractic Attorneys (NACA) -- one rep.

Charles "Skip" Lantz, DC, PhD, director of research at Life Chiropractic College West, had this to say about the conference:

"Although no substantive work was done on the Mercy document itself, the plans were laid and the organizations created that would complete that process as well as initiate work in other areas, such as pediatrics, orthopedics, or neurology. The group put in place the means of assuring quality, validity, and representation without compromising the integrity of the process.
"In principle, we now have a resolution to the current and future problems with guidelines' development -- a visible, responsible body to address relevant issues on an ongoing basis. I believe we have a solution that we can all be proud of."

The panel recommended that the first task of the Council should be to review the Guidelines for Chiropractic Quality Assurance and Practice Parameters, commonly known as the Mercy document, for those topics that should be revised. The Council will be soliciting recommendations from the profession in the near future.

Also recommended were the priorities of new topics for guidelines' development. In order of recommendation, they are: soft tissue, chiropractic and primary care, pediatrics, quality assurance, and the vertebral subluxation complex.

The Council's board of directors will be responsible for the formation of a commission to insure a proper guidelines' process. This commission will be comprised of the following positions: Commission

clinical chiropractor
epidemiologist
health economist
statistician
health care (ethics)
managed care administrator
health policy/services
information resources
insurance/business representative
literature synthesist
consumer/patient/labor representative
formal consensus expert
clinical decision expert
algorithm developer
technical editor

All professional members of the commission must be published in peer-reviewed, indexed literature in their own discipline. At least 30 percent of the commission must be comprised of non-chiropractors. At least two members must represent the consumer/patient/labor perspective. The board will also appoint an ex-officio member.

The Council will receive financial support from the chiropractic organizations represented, and from outside sources. It will also be necessary for the chiropractic supplier community to add their financial support (please see "Sponsors of the Guidelines' Development Planning Conference" on page XX).

Rick McMichael, DC, president of the Congress of Chiropractic State Associations (COCSA), offered these comments:

"The plan to form a central authority, the Council on Chiropractic Guidelines and Practice Parameters, met with unanimous agreement of the 16 conferees who represented state associations in five districts of COCSA, ACA, ICA, CCE, FCLB, NACA and others. The council will consist of a board of directors and a commission. The board, with broad representation from the chiropractic community, research, academic and clinical, will serve in an oversight capacity. They will set policy, select commission members, set priorities and initiate guideline and parameter development panels. The commission will evaluate and set the criteria and processes to assure credibility of the guidelines we develop.
"All conferees and observers agree that we must move forward in the development of chiropractic guidelines and parameters. We must move forward with due speed while assuring the credibility of the process and allowing for the oversight, input and review of field practitioners affected by the guidelines developed. This Council of Chiropractic Guidelines and Practice Parameters is structured to accomplish that mission. The agreement accomplished at this conference should allow us to move forward together.
"The establishment of a central authority to oversee chiropractic guideline development is all important to our profession and the patients served by doctors of chiropractic. Business, industry, governmental agencies and the public are all interested in practice parameters that improve the safety, effectiveness and efficiency of chiropractic care. The chiropractic profession is concerned that guidelines and parameters developed are credible, up-to-date and flexible enough for practical application to clinical practice. The Council on Chiropractic Guidelines and Practice Parameters will allow our profession to plan and coordinate this important effort."

The Congress of Chiropractic State Associations must now vote to commission the Council. COCSA's annual meeting will be addressing this issue November 4-7, 1993 in New Orleans.

David Chapman-Smith, LLB (hons), who acted as conference facilitator, gave this perspective:

"The Planning Conference was an excellent meeting. It presented limited time to achieve a major goal -- in essence agreement upon a credible structure and process for future development of practice guidelines in the chiropractic profession.
"This demand detailed preparation, fair representation, opportunities for full debate, and unanimous agreement upon a workable solution. All of this was achieved in a highly constructive manner, illustrating the depth and effectiveness of current chiropractic leadership when everyone focuses on a mutually important goal."

The panel ended the conference by unanimously approving the following statement:

"The members of the Guidelines Development Planning Conference wish to recognize and comment upon the contribution of three groups within the chiropractic profession.
"Firstly, the Conference acknowledges the important contribution and future contributions of field practitioners. The Conference also recognizes that throughout the ongoing process of development of guidelines there must always be safeguards to protect the legitimate interest of all who practice chiropractic. These safeguards should include strong representation on all panels establishing practice guidelines as well as peer review and pilot studies of future guidelines before they are released. The Conference also acknowledges and congratulates those field practitioners who will provide the guidelines process and the profession with vital leadership and support in years before us. These are the field practitioners who are taking the time to read the research literature and become actively involved in supporting and performing chiropractic practice-based research. A special vote of thanks is extended to these doctors.
"Secondly, the Conference acknowledges the efforts of chiropractic scientists. Without their specialized knowledge and assistance the current development of guidelines, and many accomplishments of the profession during the past 10 years, would not have been possible.
"Finally, the Conference acknowledges the academic community of the chiropractic profession. Through their efforts, our profession continues to produce quality field practitioners, chiropractic scientists and research data, the building blocks for future guideline development.
"Chiropractic scientists, field practitioners, academics, college administrators and association leaders will all need to apply their varied expertise to this process of Guideline and Practice Parameter Development. Together we will develop practice guidelines that are credible and practically applicable to the clinical practice of chiropractic."