What is the Clinical Compass© and How is it Valuable to Your Practice?
GUIDELINES
William Doggett
DC, FACO, FICC
The Clinical Compass was formed in 1995 and initially named the “Chiropractic Clinical Guidelines and Practice Parameters” (CCGPP) at the behest of the Congress of Chiropractic State Associations (COCSA) and with assistance from the American Chiropractic Association, Association of Chiropractic Colleges, Council on Chiropractic Education, Federation of Chiropractic Licensing Boards, Foundation for the Advancement of Chiropractic Sciences, Foundation for Chiropractic Education and Research, International Chiropractors Association, National Association of Chiropractic Attorneys and the National Institute for Chiropractic Research.
The Clinical Compass’ mission is to provide consistent and widely adopted chiropractic practice information, to perpetually distribute and update this data, as is necessary, so that consumers and others have reliable information on which to base informed health care decisions.
The Clinical Compass was also delegated to examine all existing guidelines, parameters, protocols and best practices
“The Clinical Compass’ mission is to provide consistent and widely adopted chiropractic practice information, to perpetually distribute and update this data. J J
in the United States and other nations with a chiropractic lens. Participation and process has been as transparent as possible and a major goal is to represent a diverse cross-section of the profession on the projects that Clinical Compass has been involved in.
Six members were appointed to represent the Congress of Chiropractic State Associations (COCSA). Other members were appointed by the organizations that created Clinical
Compass. The Clinical Compass is a steering organization comprised of 21 individuals.
16 are chiropractors with one in education, one in research and 14 in full-time private practice. There is a vendor representative, a representative from chiropractic colleges and attorneys representing the National Association of Chiropractic Attorneys, as well as a public member. A research commission with several dozen members reports to and is supervised by the Clinical Compass members.
Clinical Compass researches and rates evidence, which is compiled in a summary document for the chiropractic profession and other related stakeholders. The information contained in the eight clinical chapters covered in this project, being assembled by Clinical Compass, is a literature synthesis. A literature synthesis is an academically rigorous analysis of all the available scientific literature on a specific topic. Reviewers use internationally accepted tools to rate each article according to specific criteria. These include the type of study (randomized controlled trial, case series, etc), the quality of the study, size of the study and many other factors which influence the credibility and strength of the
“To assist comprehension and ease of application, the synthesis will be translated for use in the treatment room via a DIER (Dissemination, Implementation, Evaluation, and Revision) 5 J
study’s conclusions. Each reviewer independently rates all the available articles, and the ratings are compared among the members of the review team. When there is disagreement among the reviewers regarding the conclusions, a formal consensus process is followed to arrive at an overall conclusion upon which all reviewers can agree. The resulting conclusions do not represent the reviewers’ own beliefs but rather what the literature actually supports. A literature synthesis is a starting point. It indicates only what we can conclude with supportable, scientific evidence. Appropriate therapeutic approaches will consider the literature synthesis as well as clinical experience, coupled with patient preferences in determining the most appropriate course of care for a specific patient.
After Clinical Compass teams with specific skills review and rate all information gathered from multiple databases (synthesis), this information is then translated into easily usable tools. The synthesis is not the Compass®, it is merely evidence stratification for the most common conditions seen by chiropractic doctors.
Clinical Compass recognizes that information in this format is difficult to digest and implement. To assist comprehension and ease of application, the synthesis will be translated for use in the treatment room via a DIER (Dissemination, Implementation, Evaluation, and Revision). This process will ultimately produce the Chiropractic Clinical Compass®. In addition, in today’s ever-changing health care enviromnent, the literature synthesis can be used for many purposes and Clinical Compass is flexible and responsive to rapidly changing trends and needs.
How is all of this valuable to you as a doctor in the field?
Recently there was a chiropractic malpractice case heard in the South Carolina Circuit Court in Georgetown County. In this case, which involved the treatment of a patient injured in a motor vehicle accident 15 years prior, the insurance company sued the treating chiropractor. Their position, as stated by the chiropractor that they hired, was that the patient had been treated in excess of the professional standards and should have been referred to a different, non-chiropractic, provider after just 2-4 visits. They contended that the failure to refer the patient at that early time was a violation of practice standards by the
■ " The patient had been treated in excess of the professional standards and should have been referred to a different, non-chiropractic, provider after just 2-4 visits. JJ
treating chiropractor and thus malpractice. That opinion was based on the absence of specific or significant improvement in the patient’s condition contained in the treatment notes. The defense hired a chiropractic expert witness who reviewed the treatment notes and treatment schedule and then used the acute care algorithm developed by the Clinical Compass and published in the Journal of Manipulative Physiological Therapeutics (JMPT) in 2015. The defense expert witness explained to the jury that these guidelines were developed for the treatment of acute back pain as described above and were considered professional standards. The jury took less than one hour to decide that the treatment was indeed within professional standards and that there had been no malpractice by excessive treatment.
When the Clinical Compass was started by COSCA many were afraid that this was going to be perceived as just another guideline to be used by the insurance industry as they had the Mercy Guidelines to limit and restrict chiropractic practice. Now the validity and relevance of the Clinical Compass documents has been upheld in a court of law and demonstrates that the haid work of those members of Clinical Compass is valuable
and useful to all chiropractors who treat patients suffering from injury or disease.
You can access the chapters online at www.clinicalcompass.org under the resources tab drop down at clinical guidelines. While you’re at the site look into the topics under the Rapid Resource Response Center, (R3C). It has much valuable information that can benefit the doctor in the field regarding the standards in treating many other conditions. One tab over in the drop downs is the donation tab. The work that the members of the Clinical Compass do is funded by donations from state and national chiropractic associations and individuals such as you. Consider making a donation, or ask your state association to donate so that Clinical Compass can continue to inform and protect DCs as they have since 1995.
Dr. Doggett graduated with honorsfrom Los Angeles Chiropractic College in 1982 and began practicing in Albuquerque New Mexico the following year. He became a diplomate in the field of chiropractic orthopedics, studying under Dr. Rick Ackerman through Logan Chiropractic College's post-graduate department. He participated in the Wrangler ProSport chiropractic program for more than 10 years taking care of rodeo competitors at the professional, college and amateur levels. From 2003 through 2011, Dr. Doggett was the vice-chair and rules chairman of the New Mexico Board of Chiropractic Examiners. In 2010 he was elected to the position of Chairman of the examining board and served there until the end of his appointment in July 2012. He has been responsible for developing rules related to the 2008 addition of a chiropractic Advanced Practice registry in New Mexico. You may reach Dr. Doggett via email: rodeodcJfaol.com
