MERCY CONFERENCE ~ MAJOR RECOMMENDATIONS
 
   

Guidelines for Chiropractic Quality Assurance
and Practice Parameters

The Mercy Conference ~ Major Recommendations

This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to:   Frankp@chiro.org
 
   

1993 • Aspen Publishers, Inc.

Thanks to the National Guideline Clearinghouse™ (NGC), a public resource for evidence-based clinical practice guidelines, for the use of this document!


Preventive Maintenance Care and Public Health:

  • Preventive/Maintenance Care

    1. Disclosure:

      Preventive/maintenance care is discretionary and elective on the part of the patient. When recommended, it is necessary for the practitioner to clearly identify the type and nature of this care and to give proper patient disclosure.

      Rating: Established
      Evidence: Class III
      Consensus Level: 1

    2. Use of Chiropractic Adjustments:

      The clinical experience of the profession developed over a period of nearly 100 years suggests that the use of chiropractic adjustments in a regimen of preventive/maintenance care has merit.

      Rating: Equivocal
      Evidence: Class III
      Consensus Level: 1

    3. Health Screening:

      The importance of health preventive strategies is widely recognized. These services may have value in identifying early or potential manifestations of a health problem.

      Rating: Promising to Established
      Evidence: Class II, III
      Consensus Level: 1

    4. Health Promotion:

      Preventive orientation to health through health promotion is well established. Health promotion provides the opportunity for chiropractic practitioners to promote health through assessment, education, and counseling on topics such as nutrition, exercise, stress reduction, life style patterns, weight reduction, smoking cessation, and ergonomics, among others.

      Rating: Established
      Evidence: Class I, II, III
      Consensus Level: 1

    5. Wellness Care:

      Chiropractic is the largest of the holistic-oriented professions. Wellness and health management lifestyle strategies have gained popularity and acceptance. Chiropractic practitioners may choose to expand their practices to include those interventions that may influence a person’s attainment of optimum performance and behavior, and in so doing, improve health status. This kind of care is performance specific (i.e., quality of life) rather than condition (e.g., symptom) specific.

      Rating: Equivocal
      Evidence: Class III
      Consensus Level: 1

  • Public Health Considerations

    1. Community Screening:

      Community-based screening programs are commonly used by all disciplines to promote public health. Spinal screening and blood pressure checks offer excellent examples of such programs.

      Rating: Promising
      Evidence: Class II, III
      Consensus Level: 1

    2. Public Health Considerations:

      The chiropractic profession has recognized the need to engage in the local, state, national and international agendas of public health. Such programs provide opportunities for education and understanding programs regarding spinal health, nutrition, exercise and life styles, drugs, alcohol, tobacco, and infectious disease, as well as environmental and other social issues.

      Rating: Promising
      Evidence: Class II, III
      Consensus Level: 1


  • Professional Development:

    1. Continuing Education

      1. It is expected that every practitioner shall participate in continuing education.

        2. Rating: Necessary
        Evidence: Class I, II, III
        Consensus Level: 1

      2. Continuing education should be ongoing and should facilitate successful clinical performance.
        Rating: Recommended
        Evidence: Class I, II, III
        Consensus Level: 1

      3. Completion of mandatory continuing education requirements for license renewal does not necessarily assure continuing competency. Those requirements should include assessment of outcomes by administering institutions/organizations to evaluate the effectiveness of their programs.
        Rating: Recommended
        Evidence: Class I, II, III
        Consensus Level: 1

      4. Continuing education should allow for a variety of instructional formats.
        Rating: Recommended
        Evidence: Class II, III
        Consensus Level: 1

      5. Practitioners should continue to educate themselves through critical reading and review of clinical and/or scientific literature.
        Rating: Recommended
        Evidence: Class II, III
        Consensus Level: 1

    2. Postgraduate Education

      1. All chiropractic colleges are encouraged to provide residency programs for qualified graduates for the purpose of advanced research, education and clinical practice.
        Rating: Recommended
        Evidence: Class II, III
        Consensus Level: 1

      2. Colleges should provide opportunities for postgraduate programs for professional development which may lead to certification or specialty status.
        Rating: Recommended
        Evidence: Class II, III
        Consensus Level: 1

      3. Practitioners are encouraged to participate in certification or specialty postgraduate education programs (e.g., specialty programs). It is expected that every practitioner shall participate in continuing education.
        Rating: Discretionary
        Evidence: Class II, III
        Consensus Level: 1

      4. Where such postgraduate programs exist the impact and outcome should be measured appropriately.
        Rating: Recommended
        Evidence: Class II, III
        Consensus Level: 1

      5. Proprietary programs should affiliate with accredited educational institutions for the purposes of development, evaluation and implementation.
        Rating: Recommended
        Evidence: Class II, III
        Consensus Level: 1

    3. Graduate Education

        1. Practitioners are encouraged to participate in programs providing graduate education (e.g., masters or doctorate) offered by accredited educational institutions.
          Rating: Discretionary
          Evidence: Class II, III
          Consensus Level: 1

    4. Professional Organizations

      1. Practitioners should be members of one or more professional associations.
        Rating: Recommended
        Evidence: Class II, III
        Consensus Level: 1

        Comment: Professional organizations and associations provide a structure of responsibility through which members develop and maintain awareness of professional developments and gain enhanced professional competence. Practitioners also develop leadership abilities by participating in sponsored conventions, conferences, workshops and other gatherings; receive publications pertinent to the profession; support and encourage legislative programs and otherwise influence public policy in the interests of the public and the profession.


    5. Ethics/Standards of Conduct

      1. Practitioners should conduct themselves in a manner consistent with a professional code of ethics which addresses morality, honesty and all aspects of professional conduct.
        Rating: Necessary
        Evidence: Class I, II, III
        Consensus Level: 1

      2. Practitioners who advertise should do so in a responsible, ethical and professional manner.
        Rating: Necessary
        Evidence: Class I, II, III
        Consensus Level: 1

        Comment: The responsibility for regulation of advertising lies with professional associations and licensing boards. Professional organizations can assist by enforcing guidelines established for the membership; the state licensing boards promulgate rules to aid the profession and safeguard the public. Violation of state or provincial laws can result in fines or suspension or revocation of a license.


    6. Research

      1. Practitioners are encouraged to participate in research and support institutions/organizations conducting research, for the purposes of professional development and improved patient care. Valid research requires appropriate research protocols as approved by recognized institutional review boards.
        Rating: Recommended
        Evidence: Class I, II, III
        Consensus Level: 1


    DEFINITIONS:

    Procedure Ratings (System I)

    This system is suited to scientific/technical areas of practice.

    Quality of Evidence

    The following categories of evidence are used to support the ratings.

    Class I:Evidence provided by one or more well-designed controlled clinical trials; or well-designed experimental studies that address reliability, validity, positive predictive value, discriminability, sensitivity, and specificity.

    Class II:Evidence provided by one or more well-designed uncontrolled, observational clinical studies such as case control, cohort studies, etc.; or clinically relevant basic science studies that address reliability, validity, positive predictive value, discriminability, sensitivity and specificity; and published in refereed journals.

    Class III:Evidence provided by expert opinion, descriptive studies or case reports.

    Strength of Recommendation Ratings

    Type A: Strong positive recommendation. Based on Class I evidence or overwhelming Class II evidence when circumstances preclude randomized clinical trials.

    Type B: Positive recommendation based on Class II evidence.

    Type C: Positive recommendation based on strong consensus of Class II evidence.

    Type D: Negative recommendation based on inconclusive or conflicting Class II evidence.

    Type E: Negative recommendation based on evidence of ineffectiveness or lack of efficacy based on Class I or Class II evidence.

    Procedure Rating (System II)

    This system is suited to procedural/administrative aspects of practice. Accordingly it is used in chapters such as History and Physical Examination, Record Keeping and Patient Consents and Collaborative Care. One can discover which rating system is being used by looking at Part V (Assessment Criteria) of each chapter.

    Quality of Evidence

    The following categories of evidence are used to support the ratings.

    Class I:

    1. Evidence of clinical utility from controlled studies published in refereed journals.

    2. Binding or strongly persuasive legal authority such as legislation or case law.

    Class II:

    1. Evidence of clinical utility from the significant results of uncontrolled studies in refereed journals.

    2. Evidence provided by recommendation from published expert legal opinion or persuasive case law.

    Class III:

    1. Evidence of clinical utility provided by opinions of experts, anecdote and/or by convention.

    2. Expert legal opinion.

    • NGC STATUS:

    The NGC summary, including these Major Recommendations, was completed by ECRI on May 5, 1999. The information was verified by the guideline developer as of June 30, 1999.

    COPYRIGHT STATEMENT:

    This NGC Summary, including these Major Recommendations, is based on the original guideline, which is copyrighted by Aspen Publishers, Inc. Sections of this NGC Summary are reprinted with permission from Haldeman S, Chapman-Smith D, Petersen DM Jr. Guidelines for Chiropractic Quality Assurance and Practice Parameters: Proceedings of the Mercy Center Consensus Conference, Copyright 1993 by Aspen Publishers, Inc. All rights reserved. The content available through the National Guideline Clearinghouse is protected by copyright and other intellectual property laws and may not be reproduced, sold, published, broadcast, or circulated to anyone, including but not limited to others in the same company or organization, without the express prior written consent of Aspen Publishers, Inc. Requests for permission to photocopy may be directed to Permissions Department, Aspen Publishers, Inc., 200 Orchard Dr, Gaithersburg, MD 20878; fax, (301) 417-7550

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