What Constitutes 'Appropriate Care' for Low Back Pain?: Point-of-Care Clinical Indicators From Guideline Evidence and Experts (the STANDING Collaboration Project)
| Autor: | Stephen Jan, Chris Needs, Ivan Lin, Andrew Dwyer, Peter O'Sullivan, Rachelle Buchbinder, Andrew M. Briggs, G. Lorimer Moseley, Louise Wiles, Peter Hibbert, Petrina Casey, Roya Dabestani, Ian A. Harris, Malcolm Hogg, Kieran Fallon, Jacqueline H. Stephens, William B. Runciman, Charlotte J. Molloy, Helen Slater, Debra Kay, Jeffrey Braithwaite, Christopher G. Maher, Kal Fried |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Value (ethics)
Consensus Delphi Technique business.industry Point-of-Care Systems MEDLINE Champion Guideline Low back pain Nursing Research Design Health care Medicine Humans Orthopedics and Sports Medicine Neurology (clinical) medicine.symptom business computer Delivery of Health Care Low Back Pain Delphi computer.programming_language Point of care |
| Zdroj: | Spine. 47(12) |
| ISSN: | 1528-1159 |
| Popis: | Study design Multiround wiki-based Delphi expert panel survey. Objective To provide proof of concept for an alternative method for creating sets of nationally-agreed point-of-care clinical indicators, and obtain consensus among end-user groups on "appropriate care" for the assessment, diagnosis, acute, and ongoing care of people with low back pain (LBP). Summary of background data The provision of inappropriate and low value care for LBP is a significant healthcare and societal burden. Vague clinical practice guideline (CPG) recommendations can be difficult to apply and measure in real world clinical practice, and a likely barrier to "appropriate care." Methods Draft "appropriate care" clinical indicators for LBP were derived from CPG recommendations published between 2011 and 2017. Included CPGs were independently appraised by two reviewers using the Appraisal of Guidelines for Research and Evaluation instrument. Headed by a Clinical Champion, a 20-member Expert Panel reviewed and commented on the draft indicators over a three-round modified e-Delphi process using a collaborative online wiki. At the conclusion of each review round, the research team and the Clinical Champion synthesized and responded to experts' comments and incorporated feedback into the next iteration of the draft indicators. Results From seven CPGs and six qualitative meta-syntheses, 299 recommendations and themes were used to draft 42 "appropriateness" indicators. In total, 17 experts reviewed these indicators over 18 months. A final set of 27 indicators comprising screening and diagnostic processes (n = 8), assessment (n = 3), acute (n = 5), and ongoing care (n = 9), and two which crossed the acute-ongoing care continuum. Most indicators were geared toward recommended care (n = 21, 78%), with the remainder focused on care to be avoided. Conclusion These 27 LBP clinical indicators can be used by healthcare consumers, clinicians, researchers, policy makers/funders, and insurers to guide and monitor the provision of "appropriate care" for LBP.Level of Evidence: 4. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|