ChiroView Presents - Using Outcome Measures... Sigmund Miller, DC Dean of Academic Affairs Texas Chiropractic College „Leave your watch 5-minutes fast!¾ During recent years, this has been one of the more popular topics of conversation among the chiropractic community. My intent during the next several broadcasts is to share some ideas so you will consider implementing them into daily practice in such a way that is not cumbersome or intrusive. And yes it can be done. . . trust me! In performing utilization review for more than 15 years, I witnessed less than 1% of files containing any type of outcome measure tools. Of interest, if outcome tools where included in the chart, Activator technique was most likely being prescribed. Although I¼ve not used this approach, I "take my hat off" to those who recommended these tools be part of the patient's overall management. Without a doubt, I found information contained in outcome tools to be the most helpful in recommending that treatment continue. I have always subscribed to an "and" and not an "or" philosophy. In other words, when reading many „posts¾ doctors often „draw the line in the sand¾ stating they only believe in a wellness model, or will only treat patients with neck or back pain. I recommend embracing the „pain and wellness model! Why? Because, if nothing else, it makes good business sense and I see nothing wrong with taking this approach in order to provide as many patients as possible with chiropractic services. Look! Many patients enter our offices experiencing acute pain. Once that is resolved in short order, the "trust factor" increases. As a result, in many instances, now you can more easily begin discussing a "wellness model". In both instances, the focus is on improving the patient's quality of life. That is where outcome measure tools can provide some assistance „that is quantifiable¾. When hoping to improve the patient¼s quality of life, I always think in terms of activities the patient would like to do, but can't, for whatever reason. When providing chiropractic care, one primary goal of both patient and doctor is to help them return to those activities of daily living. When initially consulting patients, my discussion usually focused on these and other related issues. I would simply ask the patient " what would they like to do, but can't, because of how you feel? They would often respond "Play golf, dance with my husband, spend more time with my daughter or son shooting hoops", whatever! Many outcome measure tools, during the course of treatment, help evaluate the patient's ability to return to various activities of daily living. At predetermined times, selected forms should be completed by the patient which is key! This is one of excellent way to hear it "straight from the horses mouth"! Most importantly, that includes payers when they are questioning efficacy of treatment. In other words, patients are directly providing their perspective in regard to response to treatment. I've used this example before, but if I want to know how good the food is at a particular restaurant, I would much rather ask the patron just finishing the meal, than the chef! And many available "tools" can be easily completed by the patient, scored and then compared to previous evaluations. I look for scoring changes that are statistically significant. I will touch on that and many other related issues during my next broadcast. I see outcome tools focusing primarily on whether the patient can "do more and for longer periods of time¾ in regard to specific activities. And of course, this assessment is completed several times after the patient completes short courses of treatment. Some of the tools available include Oswestry, Roland Morris, Neck Pain Disability Index, Rand-36, SF-36, Visual Analogue Scale, General Pain Index, Pain Drawings and Patient Satisfaction Surveys. I've used them all, and believe me if I can, you can too. This ain't rocket science! By the way, a quick plug. I would pay a visit to Myo-Logic at http://www.myologic.com. Harold McCoy, DC, who runs the show, provides a free service where you can plug in the data on the Rand-36 and get an immediate "read- out". Very cool! I have spoken to Harold on many occasions. . .a real straight shooter. By the way, many of these outcome tools and other clinical forms are posted at the ChiroView Presents site. By joining as a „Member Subscriber¾ you can easily access all forms with your „username and password¾. I've set this up so each form can be saved to a file. You can easily „copy and paste" in your logo at the top of each form and you're in business. If you need some „computer techy¾ support, let me know and I can show you how it¼s done. If you are a „Member Subscriber¾, for the next broadcast, I will talk about which outcome tools to use and when, how they are scored, and „changes in scoring¾ that would be considered statistically significant. In closing, I appreciate all the kind words regarding the new ChiroView Presents site. Apparently the "Talkin' Back" section is attracting many. There I am continuously posting treatment guidelines, summaries on many clinical conditions, along with clinically-based information and research articles that is of special interest to chiropractors. Make sure you click the "refresh or reload" button on your browser each time you visit to update all information posted. Please rate this broadcast 1-5 [1=I'm putting you to sleep and 5=great stuff]! And don¼t forget to give me some feedback on this or any other issues previously discussed. In closing, I would like to express my gratitude to the following associations and business partners for supporting and promoting this weekly broadcast. And in return, would respectfully request that you consider visiting these sites to take advantage of their products and services - 1. Foundation of Chiropractic Education & Research http://www.fcer.org 2. American Chiropractic Association http://www.amerchiro.org 3. International Chiropractors Association http://www.chiropractic.org 4. International Chiropractors Association of California http://www.icacweb.com 5. Anabolic Laboratories http://www.anaboliclabs.com 6. RKS Marketing Resources - Effective Web Sites http://www.rksmarketing.com 7. LSI International http://www.lsiinternational.com 8. ClaKen Software, Inc. http://www.claken.com 9. Myo-Logic Diagnostics, Inc http://www.myologic.com 10. National Association of the Professions http://www.nap- assn.com 11. Chiropractor Directory ‚ Links ‚ Web Pages http://www.ChiroWeb.net 12. Posture Pro V - Posture Imaging System http://www.posturepro.com 13. ChiroCode Desk Book - 2000 http://www.chirocode.com 14. Stanley Greenfield, RHU - Financial Consultant http://www.stanleygreenfield.com 15. Monday Morning Chiropractic Assistant Program http://www.chirohelper.com Please remember to tell others about the broadcasts so they, too, can sign -up. All they need to do is click http://www.ChiroViewPresents.com. Cheers! Sig Sigmund Miller, DC Dean of Academic Affairs Texas Chiropractic College 925.294.9800 x 11