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

描述（由申请人提供）：在本中心，我们将采用RAND公司开发的一种方法来研究不适当医疗保健的患病率，该方法先前已被RAND公司应用于腰痛的捏脊手法和动员（M/M）。在本中心，该方法将应用于研究M/M在捏脊治疗慢性颈椎疼痛（CCP）中的应用。然而，到目前为止，RAND方法在确定适当性时并未包括患者结果、患者偏好或成本效益，而仅包括卫生专业人员的临床判断。这些都是严重的缺勤。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。虽然重点将放在慢性颈部疼痛的脊椎指压疗法M/M上，但目标是开发一种合适的方法，可用于在实际实践中研究补充和替代医学。将对文献进行广泛的综述，并撰写系统的综述。从这篇综述中，我们将建立一套基于文献的对CCP进行M/M的适应症。一旦确定了适应症，一个由九名临床专家组成的多学科小组将审查文献综合和

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.