Outcomes Based Appropriateness/Ronald Dale Hays

Coulter, Ian

Abstract

This project will conduct a systematic literature with the support of the Systematic Review Core to locate prior work on associations between variation in chiropractic care for chronic cervical pain care and patient-reported outcomes (PROs). We will also conduct focus groups to evaluate the applicability of standardized PROs that assess patient experiences of care (Consumer Assessment of Healthcare Providers and Systems or CAHPS?) and health-related quality of life (Patient-Reported Outcomes Measurement and Information System or PROMIS?) to chiropractic patients who have experienced M/M for cervical pain. This information will be used to determine if modifications to existing measures are needed and if there are gaps that require new items. Revisions to existing items and new items will then be drafted and subjected to cognitive interviews with chiropractic patients who have experienced M/M for cervical pain. The revised and new items will be finalized based on the cognitive interviews and then included along with the CAHPS Clinician and Group Adult Visit Survey and the PROMIS-57 Survey in the national sample of chiropractic patients shared by each of the four projects in this Center of Excellence. The national sample data will be collected from a random selection of practitioners and their patients in four national sites geographically distributed across the US. Project 1 will assess the treatment given chronic cervical pain and the number of times M/M is done. Project 1 with help from the Research Methods Assessment and Evaluation Core will estimate the appropriateness of chiropractic M/M care. We will conduct a thorough evaluation of the psychometric properties of these PRO measures in the national sample of chiropractic patients with chronic cervical pain, including an evaluation of measurement equivalence by comparing the national sample responses to data collected in large samples of other patients: the CAHPS comparative database and PROMIS wave 1 sample. In addition, we will estimate the associations between appropriateness of care (defined by Project 1) and PROs in the national sample. The health-related quality of life outcomes we use will also be useful to Project 4 (Economic Based Appropriateness), especially the EQ-5D preference-based single summary score we will estimate based on the PROMIS-57 domain scores. This work provides an essential assessment of the applicability of the leading state-of-the-science patient centered outcome measures to CAM in terms of acceptability to chiropractic patients and psychometric quality. In addition, it provides unique information about the extent to which the current approach tor evaluating appropriateness of care relates to patient-centered outcomes of care. The findings of this study will provide a basis for future evaluations of the comparative effectiveness of CAM versus other health care interventions in the United States.