Abstract
OBJECTIVE: To expand the appropriateness of care methodology to include patient preferences and resource utilization, and the impact of care appropriateness on patient outcomes. DATA SOURCES/STUDY SETTING: Primary data from expert panels, focus groups, chiropractors, chiropractic patients with chronic low back pain (CLBP) and chronic cervical pain (CCP), and from internet “workers” via crowdsourcing. Study setting is a cluster sample of 125 chiropractic clinics from six US regions. STUDY DESIGN: This multicomponent methods study includes analysis of longitudinal data on patient outcomes, preferences, CLBP and CCP symptoms and healthcare utilization. DATA COLLECTION/EXTRACTION METHODS: Data were collected bi-weekly for 3 months via online surveys that included both new and legacy measures, including PROMIS and CAHPS. PRINCIPLE FINDINGS: Appropriateness panels generated ratings for 1800 CLBP and 744 CCP indications which will be applied to patient charts. Data from 2025 patients are being analyzed. CONCLUSIONS: Patient-centered care is a significant policy initiative but translating it into policy that has been clinician and research-expert based, poses significant methodological issues. Nonetheless, we make the case that patient preferences, self-reported outcomes, and financial burden should be considered in the evaluation of the appropriateness of healthcare.