Rand Center of Excellence for the Study of Appropriateness of Care in CAM

描述(申请人提供)：在这个中心，我们将采用兰德公司开发的研究不适当医疗保健流行率的方法，该方法以前曾被兰德应用于脊椎手法和松动术(M/M)治疗下腰痛。在该中心，该方法将被用于研究M/M在治疗慢性颈痛(CCP)的脊椎按摩实践中的使用。然而，到目前为止，兰德方法在确定是否合适时还没有包括患者的结果、患者的偏好或成本效益，而只是卫生专业人员的临床判断。这些都是严重的缺席。在该中心，我们建议通过在RAND适宜性方法中增加三个额外的维度来推进适宜性方法：患者结果、患者偏好和成本。虽然重点将放在治疗慢性颈部疼痛的脊椎疗法M/M上，但目标是开发一种适当的方法学，可用于在实际实践中研究补充医学和替代医学。将对文献进行广泛的审查，并撰写系统的审查。从这篇综述中，将制定一套基于文献的针对CCP进行M/M的适应症。一旦建立了适应症，一个由9名临床专家组成的多学科小组将审查文献综述和 这组适应症将被要求单独并基于文献和他们自己的临床经验(如果适用)来评估M/M对慢性颈痛的适宜性。将从分布在美国各地的四个国家网站中随机选择从业者，并随机选择他们的文件。从这些数据中抽象出了对CCP的处理，并获得了对CCP进行M/M的次数。我们还将采访到诊所就诊的患者样本，并对他们的结果进行跟踪研究。

DESCRIPTION (provided by applicant): In this Center we will adapt a method developed by the RAND Corporation for studying the prevalence of inappropriate health care and which has been previously applied by RAND to chiropractic manipulation and mobilization (M/M) for low back pain. In this Center the method will be applied to study the use of M/M in chiropractic practices for chronic cervical pain (CCP). Until now, however, the RAND method has not included patient outcomes, patient preferences or cost effectiveness in determining appropriateness but only clinical judgment from health professionals. These are serious absences. In the Center, we propose to advance appropriateness methods by adding three additional dimensions to the RAND appropriateness methods: patient outcomes, patient preferences and cost. Although the focus will be on chiropractic M/M for chronic neck pain the objective is to develop an appropriateness methodology that can be used for the study of Complementary and Alternative Medicine in real practices. An extensive review of the literature will be done and a systematic review written. From this review a set of indications based on the literature for performing M/M for CCP will be developed. Once the indications have been created a multidisciplinary panel of nine clinical experts will review the literature synthesis and the set of indications individually and based on the literature and their own clinical experience where applicable, will be asked to rate the appropriateness of M/M for chronic cervical pain. A random selection of practitioners will be selected from four national sites geographically distributed across the US and a random selection of their files is chosen. From these data are abstracted about the treatment given for CCP and the number of times M/M is done for CCP is obtained. We will also interview a sample of patients attending the clinics and do a follow study for their outcomes.