Marchiori DM, Smith M, McLean ID; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1999; 16: 377.
Palmer Center for Chiropractic Research, Davenport, IA 52803, USA.
RESEARCH OBJECTIVE: The creation and implementation of practice guidelines involves documenting and understanding existing practice norms and practice variation, identifying how and why existing clinical practice may conflict with the current scientific evidence base of "best" practice, and exploring the feasibility and effectiveness of various means and approaches to reconciling existing practice patterns to "best" practice standards. This study aims to determine the utilization rate of spinal radiographs for musculoskeletal complaints in a chiropractic educational clinic, identify the prevailing reasons for ordering such diagnostic radiographs, and assess the effect of an educational intervention on clinician patterns of diagnostic imaging referral. STUDY DESIGN: Data collected on all new patients (n=1050) presenting to a chiropractic teaching clinic during an 8-month period. Following 4-month baseline data collection, clinicians were randomly assigned to an educational intervention consisting of a 2-day interactive seminar reviewing the scientific evidence base on the use of radiography in chiropractic diagnostic protocols. Follow-up data collected for 4 months post-intervention. PRINCIPAL FINDINGS: Overall, 22% of all new chiropractic patients received spinal films, with most presenting complaints being pain-related (neck, mid-back, low-back, abdominal, and headache). Reasons cited by chiropractic clinicians for imaging referral ranged from those used in development of a specific chiropractic clinical management plan to safety/legal considerations (e.g., determine presence of contraindications to spinal manipulation). Further analyses are underway. CONCLUSIONS: Chiropractic clinicians utilize diagnostic radiography at rates comparable to those of other similar providers. Marked practice variation exists for this sample of clinicians, also similar to other provider types. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Findings from this study will further affect efforts at improving the quality of chiropractic care by identifying best practice standards and effective approaches for guiding clinicians to establish and maintain such standards in practice.
Publication Types:
Keywords:
- Chiropractic
- Complementary Therapies
- Decision Making
- Humans
- Manipulation, Spinal
- Organizations
- Practice Guidelines as Topic
- Referral and Consultation
- United States Agency for Healthcare Research and Quality
- diagnosis
- instrumentation
- radiography
- hsrmtgs
Other ID:
UI: 102194751
From Meeting Abstracts