ChiroView Presents - NPDI Outcome Assessment. . . "A friend walks in. . .when everyone else walks out"! I personally believe the Neck Pain Disability Index [NPDI], by far and away, is one of the more effective and reliable outcome tools when objectifying response to care with those patients reporting cervical complaints. In addition, I strongly suggest using the NPDI whenever evaluating and treating workers' compensation or personal injury claims. They are also helpful when interacting with group health carriers, 3rd party administrators, employers and nurse case managers. As an aside, given the additional time you need to spend when using the NPDI during initial and interim exams, I would typically inform payers, when performing UR, that it is appropriate for the doctor to "bump" EM services from 99203 to 99204, and interim/final exams from 99213 to 99214. Whether appearing at depositions on behalf of the patient's attorney or payer, attending a binding arbitration, appearing at trial, or reviewing a claim, if properly completed, scored, and interpreted, I witnessed the NPDI data serving as a decisive tool when determining appropriateness of chiropractic services previously prescribed. On the other hand, improper use of the NPDI can spell disaster. That is not to say that pain scales, excellent SOAAPing format [remember the extra "A"], proper narrative reporting, patient satisfaction surveys along with other tools, are not extremely helpful in supporting the need for chiropractic services when being challenged by any 3rd party payer. But I am partial to NPDI because I've witnessed, on many occasions, how scoring these forms can have a profound positive impact on those challenging your recommendations. Consider using the NPDI during - 1. Initial evaluation 2. Following initial 2-weeks of care 3. One-month intervals 4. When "flare-ups" are reported to establish an updated baseline score 5. Final evaluation The NPDI form can be completed by the patient in less than 3-5 minutes and scored by you or your assistant in less than one minute. The patient should complete the form on the day of their appointment, just prior to evaluation or treatment. As a "member subscriber", you can easily download a copy of the NPDI, along with Oswestry, Roland Morris, General Pain Index, pain scales, patient satisfaction survey and about 15 other clinical and outcome forms. Just go to http://www.ChiroViewPresents.com site, enter your "username and password". I set every form up so you can copy and paste in your logo, as well. NPDI is designed to assist the doctor in better understanding how neck pain presently affects the patient's ability to performe various activities of daily living [ADL's]. There are ten distinct categories with six choices in each. The patient is requested to check-off one of the six boxes in each category. If the patient marks the first box, then that category is scored with a "0". In descending order, each box, if marked, carries an additional one-point value. In other words, the last box checked in the category is valued at "5 points". Scoring ranges 0-50. The higher the score, the more intense the pain levels when performing ADL's. It has been my experience that acute patients typically score low 30's to low 40's. To simplify the process [nothing wrong with that!], I treat this score as a relative measurement. I will use this number and compare it to the follow-up score completed 2-4 weeks out. I also look for a "statistically significant" improved score of at least 5 -points when comparing one evaluation to the next. By the way, in my narrative report, I have a separate heading entitled "outcome measures" where data is entered regarding all assessments and their follow-up scores. To view an example of this, go to the Talkin' Back section at our site and click "forms section". I posted a "sample narrative" used for PI which outlines changes in outcome measure scoring. From my experience, this is one of the more valuable sections of the narrative report. One final point. . . and I believe it is an important one. Assume you are putting together your "case presentation summary" on a worker's compensation or personal injury file. That includes your final narrative report, daily charting, exam forms, etc. Let's say the payer/defense attorney wanted me to "take a look" at the file. There is no question in my mind that a solid well- documented presentation by the treating doctor "always" beats the best defense. Most importantly, that includes using an outcome measure [ie NPDI], along with pain drawings, patient satisfaction surveys, pain scales, and a SOAAPing format that includes "activity assessment".