Clinician Based Appropriateness/Ian Coulter

基于临床医生的适当性/Ian Coulter

• 批准号: 8573681
• 负责人: Ian Douglass Coulter
• 金额: $ 33.72万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-30 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8573681
• 关键词: Area; Caring; Chiropractic manipulation; Chiropractor; Chronic neck pain; Clinical; Clinical Sciences; Data; Data Collection; Diagnostic tests; Economics; Equilibrium; Evidence based practice; Goals; Health Care Costs; Health Occupations; Health Sciences; Healthcare; Judgment; Literature; Low Back Pain; Medical; Medical History; Medicine in Art; Meta-Analysis; Methods; Outcome; Patient Preferences; Patients; Prevalence Study; Procedures; Process; Random Allocation; Research; Resolution; Review Literature; Sampling; Science; Scientist; Site; Symptoms; Time; Work; Writing; abstracting; base; chiropracty; clinical care; clinical practice; cost; data management; evidence base; experience; meetings; member; multidisciplinary; preference; response; systematic review

This project will adapt a method developed by the RAND Corporation for studying the prevalence of inappropriate health care and which has been previously applied by RAND to chiropractic manipulation and mobilization (M/M) for low back pain. In this Project the method will be applied to study the use of M/M in chiropractic practices for chronic cervical pain (CCP). An extensive review of the literature will be done and a systematic review written (a meta-analysis if this is possible but a synthesis if it is not) with the support of the Systematic Review Core (SRC). From this review a set of indications based on the literature for performing M/M for CCP will be developed. These indications will categorize patients in terms of their symptoms, past medical history, and the results of previous diagnostic tests. The review will also look at the evidence for patient preferred outcomes (from Project 2: Outcomes- Based Appropriateness), patient preferences (from Project 3: Patient Preferences Appropriateness) and costs (from Project 4: Economic-Based Appropriateness). Once the indications have been created (and reviewed by experts in the field) the process to be used is a modified Delphi. A multidisciplinary panel of nine clinical experts will initially receive the literature synthesis and the set of indications individually and based on the literature and their own clinical experience where applicable, will be asked to rate the appropriateness of M/M for chronic cervical pain. The panel will then be brought together in a face-to-face meeting and the results of these ratings are then circulated to the panel members. Following group discussions, and revising of the indications, the panels re-rate the indications. In further round of ratings the panel will be given data on patient preferences preferences (from Project 3: Patient Preferences Appropriateness), outcomes (from Project 2: Outcomes-Based Appropriateness), and costs (from Project 4: Economic-Based Appropriateness. Once the work of the expert panel is completed, RAND will generate a set of indications for doing M/M for CCP based on the evidence and clinical experience of the panelists which can then be used to compare actual practice

该项目将采用兰德公司开发的一种方法，用于研究不当医疗保健的流行情况，兰德公司此前已将该方法应用于治疗腰痛的脊椎按摩疗法和动员（M/M）。在本项目中，该方法将用于研究 M/M 在慢性颈椎疼痛 (CCP) 脊椎按摩疗法中的应用。 在系统审查核心 (SRC) 的支持下，将对文献进行广泛的审查，并撰写系统审查（如果可能，则进行荟萃分析，如果不可能，则进行综合）。根据本次审查，将开发一套基于文献的针对 CCP 进行 M/M 的适应症。这些适应症将根据患者的症状、既往病史和之前的诊断测试结果对患者进行分类。审查还将关注患者偏好结果（来自项目 2：基于结果的适当性）、患者偏好（来自项目 3：患者偏好适当性）和成本（来自项目 4：基于经济的适当性）的证据。一旦创建了适应症（并由该领域的专家审查），所使用的流程就是修改后的 Delphi。由 9 名临床专家组成的多学科小组最初将分别收到文献综述和一组适应症，并根据文献和他们自己的临床经验（如果适用），将被要求评估 M/M 治疗慢性颈椎疼痛的适当性。然后，该小组将召开面对面会议，并将评级结果分发给小组成员。经过小组讨论并修改指示后，专家组重新评估指示。在下一轮评级中，专家组将获得有关患者偏好（来自项目 3：患者偏好适当性）、结果（来自项目 2：基于结果的适当性）和成本（来自项目 4：基于经济的适当性）的数据。专家小组的工作完成后，兰德公司将根据小组成员的证据和临床经验生成一套针对 CCP 进行 M/M 的指征，然后可用于比较实际操作