Rand Center of Excellence for the Study of Appropriateness of Care in CAM

兰德 CAM 护理适当性研究卓越中心

• 批准号: 8551832
• 负责人: Ian Douglass Coulter
• 金额: $ 236.01万
• 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/8551832
• 关键词: American; Area; Caring; Cervical; Chiropractic manipulation; Chiropractor; Chronic neck pain; Clinic; Clinical; Complementary and alternative medicine; Data; Dimensions; Evaluation; Frequencies; General Population; Health; Health Professional; Healthcare; Interview; Judgment; Literature; Low Back Pain; Methodology; Methods; Musculoskeletal; Neck Pain; Outcome; Patient Preferences; Patients; Prevalence Study; Random Allocation; Review Literature; Sampling; Scientist; Site; Time; Writing; abstracting; base; chiropracty; cost; cost effectiveness; experience; multidisciplinary; public health relevance; systematic review

DESCRIPTION (provided by applicant): In this Center we 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 Center the method will be applied to study the use of M/M in chiropractic practices for chronic cervical pain (CCP). Until now, however, the RAND method has not included patient outcomes, patient preferences or cost effectiveness in determining appropriateness but only clinical judgment from health professionals. These are serious absences. In the Center, we propose to advance appropriateness methods by adding three additional dimensions to the RAND appropriateness methods: patient outcomes, patient preferences and cost. Although the focus will be on chiropractic M/M for chronic neck pain the objective is to develop an appropriateness methodology that can be used for the study of Complementary and Alternative Medicine in real practices. An extensive review of the literature will be done and a systematic review written. From this review a set of indications based on the literature for performing M/M for CCP will be developed. Once the indications have been created a multidisciplinary panel of nine clinical experts will review 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. A random selection of practitioners will be selected from four national sites geographically distributed across the US and a random selection of their files is chosen. From these data are abstracted about the treatment given for CCP and the number of times M/M is done for CCP is obtained. We will also interview a sample of patients attending the clinics and do a follow study for their outcomes.

描述（由申请人提供）：在该中心，我们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，兰德公司之前已将该方法应用于治疗腰痛的脊椎按摩手法和动员 (M/M) 。在该中心，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。然而，到目前为止，兰德方法在确定适当性时尚未包括患者结果、患者偏好或成本效益，而仅包括卫生专业人员的临床判断。这些都是严重的缺席。在该中心，我们建议通过在兰德适当性方法中添加三个额外维度来推进适当性方法：患者结果、患者偏好和成本。尽管重点是针对慢性颈部疼痛的脊椎按摩疗法 M/M，但目标是开发一种可用于实际实践中补充和替代医学研究的适当方法。将进行广泛的文献综述并撰写系统综述。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。一旦确定了适应症，由九名临床专家组成的多学科小组将审查文献综合并 根据文献和他们自己的临床经验（如果适用），将要求单独评估 M/M 对慢性颈椎疼痛的适当性。将从分布在美国各地的四个国家站点中随机选择从业者，并随机选择他们的文件。从这些数据中可以提取出有关 CCP 的治疗情况，并获得对 CCP 进行 M/M 的次数。我们还将采访到诊所就诊的患者样本，并对他们的结果进行跟踪研究。