What is the difference between "guideline" and "best practice"?
ODG, now in its 19th year of publication, is succinct, straightforward, complete, and authoritative – based on an aggregate of over 10 million cases and decades of research, including an ongoing systematic medical literature review to make tangible and accessible the results of important and emerging medical evidence to minimize the impact of illness and injury on health, productivity and quality of life, reducing costs for employers, TPA, insurers, and health plans. Work Loss Data Institute is pleased to introduce ODG 2014.
The ODG guidelines have realized considerable acceptance – more than 75,000 users worldwide, adoption by federal, state and local governments, widespread use by insurance plans, TPA’s, and allied health organizations – because:
1) ODG is independent of any medical specialty group and multidisciplinary in scope.
2) ODG takes evidence-based guidelines to their logical end point; the conclusions are linked directly to the evidence in the studies and references.
3) ODG is continuously updated reflecting the findings of new studies as they are conducted and released; subscribers are always up to date.
4) ODG is designed for both clinical practice and utilization review (UR).
5) ODG seeks clarity in recommendations.
6) ODG allows the ability to copy/paste and export the guidelines into claim specific forms, saving time and effort in documenting approvals or denials of treatment or expected disability duration.
7) ODG has been accepted by the Agency for Healthcare Research & Quality (AHRQ) for inclusion in the National Guideline Clearinghouse www.guidelines.gov
In short, a guideline contains numbers/suggested therapy time frames that are often mistakenly applied as arbitrary limits.
Best Practice (BP) is a process/document that reviews the evidence and provides interpretation consistent with the chiropractic perspective as the providers involved in treating these cases, using chiropractic methods (Triano). BP is more of an ongoing dynamic process and initiative rather than just a document. The best practice initiative contains three elements: research, clinical judgment, and patient values. Consider these short definitions/explanations:
Best Practices is a "criteria document," designed for clinical decision-making according to evidence-based research. However, it is also outcome based encouraging innovation for the future of health care delivery. Allen Unruh, D.C. (CCGPP Board Member)
Best practices are clinical judgments regarding patient care that are informed by the best evidence and balanced by patient complexity and provider experience to improve the quality and reduce the costs of care. John Triano, D.C., Ph.D. (Commission Co-Chair)
Chiropractic Best Practices bring the chiropractic "Philosopher/Healer", the "Skeptic/Researcher", and the "Pragmatist/Practitioner" together on common ground to meet the needs of the chiropractic patient in the best possible manner". Wayne Bennett, D.C. (CCGPP Board Member)
The focus is on the process of care, identification of risk factors and case complexity, techniques of response monitoring, and benchmarks for intervening when the response is below average.
Guidelines should not be used as cookbooks or prescriptions for care, and should not be used to deny care as a sole reason for the denial. Many ill-informed or disingenuous consultants rely on just the research and fail to understand that "Best Practice Initiatives" include three integral components; (1) research, (2) clinical decision making, and (3) patient values.
Commonly used Guidelines:
Article About Mercy
Milliman and Robertson
Arguably the most credible treatment guideline in existence today that pertains to Chiropractic healthcare is "Mercy". However, Mercy was written in 1992 and a wealth of quality research has been performed and reported since Mercy was published. An exciting new document is being developed (due for release in 2007) by the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) that focuses on "Best Practices" vs. "Guidelines". As most clinicians have discovered, guidelines can be horribly misused and abuse by consultants and claims/case managers who do not seem to understand their limitations. Guidelines serve as background information upon which to glean an "ideal" starting point for review. Guidelines should not be used as cookbooks or prescriptions for care, and should not be used to deny care as a sole reason for the denial. Many ill-informed or disingenuous consultants rely on just the research and fail to understand that "Best Practice Initiatives" include three integral components; (1) research, (2) clinical decision making, and (3) patient values.
The Treatment Planning section outlines the most common pathways to recovery, but there is no single approach that is right for every patient and these protocols do not mention every treatment that may be recommended. See the Procedure Summaries (in the original guideline document) for complete lists of the various options that may be available, along with links to the medical evidence. The Procedure Summaries are the most important section of Official Disability Guidelines (ODG) Treatment, and that section, not the Treatment Planning section, should be used as a basis for Utilization Review.
This guideline should not be used to suggest appropriate procedures for other conditions or commodities. When the treating doctor suspects any other diagnosis, they may decide what necessary testing should be performed.
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