Should You Follow the Evidence Trail?

The Foundation for Chiropractic Education and Research (FCER) recently held a workshop titled “Translating Evidence Into Practice,” and included sessions with titles such as “Best Practices Through Application of Research Tools” and “Communicating Best Practices to Third-Party Payors.” The basic theme of the conference was that a movement is taking place to provide evidence-based health care, and that chiropractors should learn the skills necessary to develop evidence-based practices.

I have been hearing about evidence-based practice for a while now, and it has always been a vague concept to me. What constitutes an evidence-based practice?

Stephen Perle, DC, who has lectured frequently on this topic and was a presenter at the FCER event, says that the three components of an evidence-based practice are

• the use of the best available external (published) evidence;
• the doctor’s expertise on whether the patient fits the profile of patients in the published papers; and
• the patient’s wishes.

One argument in favor of an evidence-based practice is that it benefits the patient because he or she is receiving care supported by the best research. Another argument is that it would help the DC collect from third-party payors. If the best-available research says treatment A is better than treatment B, and you use treatment A, then having an evidence-based practice makes it harder for a third-party payor to claim that you are practicing outside a standard of care. Another benefit of an evidence-based practice is that you can use it as a risk-management tool. For example, if you used information from a peer-reviewed research paper to decide not to take x-rays on a patient, and a fracture is later found, a jury might be more likely to side with you if you say you used the best research rather than simply your professional opinion.

The American Chiropractic Association (ACA) has also addressed this issue. The ACA’s policy on Evidence-Based Medicine and Best Practices appears on its Web site, at www.amerchiro.org/insurance/policy/bestpractice.shtml. The policy begins with the statement that the ACA “supports Evidence Based Medicine and Best Practices that are predicated by an objective review of the most current and valid evidence available in literature and other sources.” Another organization in favor of evidence-based chiropractic is the Council on Chiropractic Guidelines and Practice Parameters (CCGPP), which was formed by various chiropractic entities to develop a “best practices” document for use by the chiropractic profession.

Some in the chiropractic industry, however, don’t believe in the concept of evidence-based practices. A representative from the International Chiropractors Association told me that although chiropractors should make maximum use of available data, the term “evidence-based” is just a “buzzword” that the insurance companies use to reduce reimbursement.

There are two sides to most issues, but in this case, I don’t believe the two sides are that far apart. Whether you are for or against evidence-based practices, you all became chiropractors to improve patients’ health naturally. If you continue focusing on patients’ health, everyone wins. CP

Daryl Lubinsky
dlubinsky@ascendmedia.com