Determining Appropriateness in the Age of Patient Centered Care

Objective: This talk presents the methods of the RAND/NCCIH Center of Excellence for Research on CAM, funded to develop a practice-based, patient-centered process for studying chiropractic care that uses manipulation/mobilization for chronic low back and cervical pain. The Center’s objective is to advance health policy methods by including patient preferences, costs, and patient-reported outcomes into the current method for determining appropriateness of care.

Methods: In this methods study, pre-post design is utilized. Expert panels will convene to rate appropriateness of chiropractic care for chronic pain based on evidence and clinical experience.  Data on patient-reported outcomes, preferences, and cost will be collected nationally from 1600 patients in 80 chiropractic clinics via systematic stratified sampling. Data will be analyzed and reported to panelists who reconvene to re-rate appropriateness of care, taking into account these new data. Ratings from first and second panel meetings will be compared to understand the effect of patient-centered outcomes on expert panels.

Results: The methods of this study will be presented. Preliminary data will be commented on, but reported at a later date.

Conclusion: This work is highly innovative in that previous appropriateness studies determined appropriate care based only on efficacy, effectiveness and safety. We expand the definition of appropriateness to match not only the needs of CAM (where patient self-referral is common, and, thus, patient preferences and resources have large roles in determining appropriate care), but also the needs of the increasing patient-centered focus and cost constraints of health care.