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What is an outcome assessment?

A procedure or method of measuring a change in a patient's status over a period of time to determine if the condition is improving, worsening or remaining unchanged


How does an outcome assessment differ from outcome management?

Outcome assessments are a collection and recording of information relative to health processes, while

Outcome management uses that information in a way that enhances patient care


What are the 6 Outcome Criteria?

1.) Utility

2.) Reliability

3.) Validity

4.) Sensitivity

5.) Specificity

6.) Responsiveness


What outcome criteria answers the question:

Is it useful?



What outcome criteria answers the question:

Is it dependable?



What outcome criteria answers the question:

Does it do what it is supposed to do?



What outcome criteria answers the question:

Can it identify patients with a condition?



What outcome criteria answers the question:

Can it identify those that do not have the condition?



What outcome criteria answers the question:

Can it measure differences over time?




Is it useful?



Is it dependable



Does it do what is supposed to do?



Can it identify patients with a condition



Can it identify those that do not have the condition?



Can it measure differences over time?


What are 4 outcome measures that are appropriate for clinical use?

1.) Questionnaires

2.) Physiological outcomes

3.) Utilization measures

4.) Cost measures


What are 4 types of questionnaires that are appropriate for clinical use?

1.) General health status

2.) Pain

3.) Functional status

4.) Patient satisfaction


When outcome measures are appropriaely used and integrated into an evidence-based, patient-centered model of practice, there is _____ and _____ _____.

Accountability and Quality Assurance


What are the 2 classifications of outcome assessment tools?

1.) Subjective

2.) Objective


What type of outcome assessment is patient driven?



What type of outcome assessment is health care provider driven?



What are 6 patient driven subjective outcome assessments?

1.) General Health

2.) Pain Perception

3.) Specific Disease or Condition

4.) Psychometric

5.) Disability Prediction

6.) Patient Satisfaction


What are 6 health care provider, objective outcome assessments?

1.) Range of Motion

2.) Strength-Endurance

3.) Non-organic

4.) Proprioception

5.) Cardiopulmonary

6.) Developmental


The ICA holds that it is the basic responsibility of the doctor of chiropractic to employ such diagnostic processes as are necessary in his or her professional judgment to determine the need for care and, in particular, to detect the presence, location, and nature of chiropractic lesions (subluxation, and attendant biomechanical, biochemical, structural, and neurophysiological problems, etc.) and prepare and administer an appropriate course of care within the realm of chiropractic speciality.

This is an example of:

Policy Statement


What are 4 things that exams are used for in a chiropractic practice?

1.) Discover cause or source of the chief complaint (CC)

2.) Determine extent of the problem

3.) R/O complications and/or contraindications

4.) Locate subluxation(s)


What are 3 things that outcome assessments are used for in a chiropractic practice?

1.) As part of exam

2.) Monitor patient status over time

3.) Evaluate other factors in the case


What are 3 Criteria for the selection of clinical exam procedures?

1.) Outcome of the test should determine the nature of care and/or prognosis

2.) Reliability: The test is reliable

3.) Cost Effective: More cost effective and equally or more reliable procedures are not available


Analysis is directly related to _____ and _____.

Technique and Care

Hugely technique driven


What are the 3 Operational Models?

1.) Segmental Models

2.) Postural Models

3.) Tonal Models


What are 5 techniques that follow the segmental model?

1.) Gonstead

2.) Diversified

3.) Activator

4.) Thompson

5.) Upper Cervical


What are 3 techniques that follow the postural model?

1.) Chiropractic Biophysics

2.) Pettibon

3.) Applied Spinal Biomechanical Engineering (ASBE)


What are 5 techniques that follow the tonal model?

1.) Upper Cervical

2.) Logan

3.) Toftness

4.) Network Spinal Analysis

5.) Torque Release


What are the 5 components of the Vertebral Subluxation Complex (VSC)?

1.) Spinal Kinesiopathology

2.) Neuropathology

3.) Myopathology

4.) Histopathology

5.) Pathology


What is spinal kinesiopathogy?

Abnormal movement and/or positioning of the spine


What is neuropathology?

Changes in nerves


What is myopathology?

Changes in muscles



What is histopathology?

Changes in other tissues


What is pathology as it relates to the VSC?

Biochemical changes, frank disease


What are 3 components to measuring functional progress?

1.) Active (muscle)

2.) Passive (bone)

3.) Control (nervous system)


What are 2 ways to measure the active functional progess of muscles?

1.) Muscle Testing

2.) EMG


What are 2 ways to measure the passive functional progress of bone?

1.) Range of Motion (ROM)

2.) X-ray


What are 3 ways to measure the control of functional progress of the nervous system?

1.) Muscle Testing

2.) NCV

3.) SSEP


What are 10 examples of qualitative clinical assessments?

1.) Perceived pain, disability and/or functional status

2.) Pain threshold or Pain tolerance

3.) Posture

4.) Range of Motion (ROM)

5.) Intersegmental ROM

6.) Muscle Strength

7.) Muscle Endurance

8.) Muscle Spasm

9.) Nerve Function

10.) Pathology


True or False

It is not important to remember to utilize the same outcome assessment tool throughout the course of case management with each patient



What are 4 steps to becoming outcome based?

1.) Utilize subjective/objective tools

2.) Score the tools at the initial visit to establish baseline measures

3.) Repeat the instrumentation after 2-4 week intervals to track the effects of treatment changes

4.) Base clinical decisions on the outcome results


What are secondary benefits to exams?

Findingd outside our scope of practice requiring referral and/or co-management


What is a chiropractic diagnosis?

An expert opinion based upon the reasoned, judgment of the DC to identify the nature and cause of the patient's subjective complaints and objective finding, which directs clinical care and case management decisions


What is included in the diagnostic process?

The integration and synthesis of all available findings, lab, imaging and other evaluations resulting in a recored opinion of the patient's health problem(s) and status


What is the reason for any clinical diagnosis?

To provide patient management for the diagosed condition


What should the primary chiropractic diagnosis focus on?

The main area of the provider's expertise:

Vertebral Subluxation Complex (VSC) and its effects on the musculoskeletal system, the nervous system and general health


What is the diagnosis of non-musculoskeletal disorders particularly important for?

The understanding of pahophysiological mechanisms of the condition and its effects on the chiropractic management of the patient


What are 5 objectives of a diagnosis?

1.) Application of proper managment plan

2.) Technique selection

3.) Formulation of prognosis

4.) Determination of appropriateness of chiropractic care

5.) Collaboration with other health care providers for the co-management of referral when indicated


What is the immediate referral protocol?

High index of suspicion with immediate threat of the patient


What are the 3 components of the referral protocol for co-management?

1.) Situation may pose a threat to the patient

2.) Another opinion is required

3.) Additional studies are required


What are 5 questions that need to be answered when referring a patient?

1.) Who is in charge of the case?

2.) Do you wish to co-manage or relinquish the patient entirely?

3.) Is the exam procedure within your scope?

4.) Are you sure which procedure to use?

5.) Do you do the exam enough to be confident with the procedure ad determining the outcome?


What are the 2 things that need to be weighed when ordering further studies?

1.) Cost to Benefit

2.) Risk to Benefit


What are 3 schools of thought when ordering further studies?

1.) Rule In: Want to confirm what your suspect

2.) Rule Out: Clinical suspicion of a condition is low, but the gravity of the possible condition is used to support further study

3.) What if?: Something there, despite absence of clinical indicators to suggest the same


What is the typical medical breakdown of diagnostic and treatment cost?

85% of cost: Diagnosis

15% of cost: Treatment


What is the typical chiropractic breakdown of diagnostic and treatment cost?

15% of cost: Diagnosis

85% of cost: Treatment


According to Kent, Target Coding if there is more documentation of VSC effects what could happen to the breakdown of diagnostic and treatment costs?

35% of cost: Diagnosis

65% of cost: Treatment


When are further studies recommended?

If there are suspicions after the initial study or if there is a significant trauma or signs of neurological injury


What are 3 additional considerations to ordering further studies?

1.) Do no harm: If there is no alteration of care or prognosis than don't do it

2.) Continue to search for a lesion if clinically suspected

3.) Do not accept films of inadequate quality


What are 7 steps in the informed decision-making process?

1.) Discuss the patient role in the decision

2.) Discuss what is at issue in the decision

3.) Discuss alternatives, including doing nothing

4.) Discuss pros and cons of alternatives

5.) Discuss the uncertainties associated with the proposed test or treatment

6.) Assess the patient's understanding

7.) Explore the patient's preferences