standards vs. guidelines

[Guest guest]

Doctors,

In year 2000, the Board issued the statement below in an attempt to address the

issue of standards vs. guidelines. Later the name of the guidelines process was

changed to the Educational Manual to further clarify the intent. As the process

has proceeded in recent years, small but important suggestions have emerged that

subsequently went through the administrative rulemaking process, without any

particular opposition. The content of the Educational Manual itself is meant to

be helpful information. It is not administrative rule as has been stated

erroneously so many times.

Dave McTeague, Ex. Dir., OBCE

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Adopted October 19, 2000

Oregon Chiropractic Physicians

From: Oregon Board of Chiropractic Examiners

Re: Practice guidelines and standards

Recent discussions have emphasized the need to clarify the distinction between

" guidelines " and " standards " as the Board and the profession move forward in

developing evidence-based clinical practice guidelines for chiropractic. In

conversations with DC's around the state, it is apparent that some have a

concern that clinical practice guidelines now in development will somehow be

construed as " rules " for practice. The fear is that the guidelines will be used

by the Board or by others to judge competency or quality of a practitioner's

performance, deny claims, or otherwise create standards by which DC's will be

judged.

The guidelines development literature deals with this potential conflict by

clearly differentiating between " guidelines " and " standards. " The Board has

adopted explicit definitions that are consistent with those found in the

literature.

" GUIDELINES are systematically developed statements to assist practitioners and

patients in making appropriate health decisions.

Guidelines are based on the best available evidence from both a systematic

review of the scientific clinical literature and consensus of expert clinical

opinion. Guidelines are presented in the form of recommendations or practice

tips that are designed to aid the practitioner in providing care to the patient.

They are options to be considered in the light of the specific clinical

circumstances presented by each patient. They are not " cookbook " prescriptions

for patient care. They are not the basis for action by the board.

" STANDARDS are authoritative statements of minimum levels of acceptable

performance.

Standards may also be defined as the highest level of performance or outcome or,

alternatively, the range of acceptable performance. We anticipate that

standards that are developed during the practice guidelines process will help

the Board define levels of minimum acceptable competency.

Standards rise above guidelines by the strength of support in both the

literature and consensus of expert opinion. Only those statements that have

strong support can be considered adequately defensible to become the basis for

policy, administrative rules and standards of minimum competency.

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>>> " kjholzdc@... " <kjholzdc@...> 02/23/06 07:44AM >>>

Well said Jack, well said...

J. Holzapfel DC

Albany

-- JPedersenDC <chirodoc1@...> wrote:

Listmates:

1) I support the notion our OBCE should be the party that develops

guidelines, as the schools and various organizations have failed to

produce a document they can all agree upon. It is required by

Legislative mandate via ORS that the OBCE license DCs in the first

place. If OBCE is responsible for such a task in the first place, then

it is reasonable they develop those professional guidelines applicable

within the state.

2) Whatever parameters or guidelines our licensing body recognizes as

appropriate and necessary to make diagnostic and therapeutic decisions,

there must be a body of academic evidence supporting the inclusion of

those parameters. It is the OBCE to which we all must be able to

demonstrate upon what our clinical reasoning is based. Our chart notes

must contain sufficient information to make that determination. Neither

the schools nor the professional organizations have the legal authority

or responsibility to determine what constitutes the practice of

Chiropractic in Oregon. Only the OBCE has the mechanism to enforce

remedy of violation of those guidelines.

3) DCs have been performing services for well over a century, and for

all too long with little to no documentation to support our clinical

claims. It's time we stipulate methods to demonstrate HOW we measure

results of chiropractic care.

4) It's time we focus on honing what DCs can prove we do for the good of

the patient. Our efforts to remodel the 'health care system' will

strengthen as we provide AS A PROFESSION undeniable quality of service

and a set of performance protocols that can not be ignored or dismissed.

We must focus on what CHIROPRACTORS do;

we must FOCUS on what CHIROPRACTORS do;

we MUST FOCUS on what CHIROPRACTORS do;

WE MUST FOCUS on what CHIROPRACTORS DO....

J. Pedersen DC

Sweet Home