• Exceptional speakers headline May 2004 NYSCA Leadership Meeting at New York Chiropractic College. Field doctors invited. Twelve hours of CE offered at no charge to members; $59 to non-members. • Healthcare system about to change . . . again! How will chiropractic cope? Given the professional press lately and the scientific discussion taking place in referred journals, members probably have heard something of the latest buzzwords in health care – evidence-based medicine (EBM) and best practices. These terms have the potential to be a double-edged sword in health care practice. Used appropriately, EBM and best practices hold the potential for advancing the quality of care patient’s receive in that EBM and best practices champion patient-centered care that is scientifically-based and individualized, and refined through quality improvement measures and clinical experience. For chiropractic, EBM and best practices provide an opportunity to advance the integration of chiropractic with mainstream healthcare. Used inappropriately, however, EBM and Best Practice could also turn out to be the newest cudgel used to batter chiropractic. Indeed, as Allan Korn, MD, Chief Medical Director of the National Association of Blue Cross and Blue Shield Plans warned attendees at the ACA National Chiropractic Legislative Conference in Washington, DC, March 4, squeezed by the surging health care inflation employers have put insurers on notice that employers are no longer willing to pay insurance premiums for care that is not evidence-based. This sentiment was echoed by ACC-RAC keynote speaker, Murray Goldstein, DO, MPH a week later at the Association of Chiropractic Colleges-Consortia sponsored Research Agenda Conference convened in Las Vegas, March 11, more then 2,000 miles away. The question is, how will evidence-based, best practice information be used and what does all this mean to the average field doctor? Come to the May 22, meeting of the NYSCA House of Delegates to find out. At the same time, members should be aware that the health care system, if it can be called a “system” at all, is on the threshold of a major overhaul, provided that some action is taken on the 2003 recommendations of the Institute of Medicine (IOM), National Academies of Science (NAS or the “National Academies”). Following a thorough, multi-year study by separate interdisciplinary committees examining all of the ills that prevail in the health care system, the IOM has called for a complete overhaul of the disorganized health care system. The import of these recommendations lies in the fact that the IOM is one of the National Academies of Science (NAS) and the NAS was chartered by Congress during the Civil War in 1863 and charged with the responsibility of advising Congress on scientific matters. Unfortunately, it appears, chiropractic has been participated in these deliberations. In the most recent studies of three IOM Studies Quality Chasm Series – “Health Professions Education: A Bridge to Quality,” the IOM convened a 150 member Task Force in July 2003 under the command and direction of the IOM Health Professions Education Summit Committee, to grapple with reshaping the disorganized health care system to make it more sensible and system-like. The Committee and Task Force developed a new vision for clinical education, one that is centered on a commitment to meeting patients’ needs, not the needs of the providers, and offered the following overarching vision: “All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches and informatics.”(1) The committee proposed a set of five core competencies that all clinicians should possess, regardless of their discipline. These include: • Provide patient-centered care -- identify, respect, and care about patients' differences, values, preferences, and expressed needs; relieve pain and suffering; coordinate continuous care; listen to, clearly inform, communicate with, and educate patients; share decision making and management; and continuously advocate disease prevention, wellness and promotion of healthy lifestyles, including a focus on population health. • Work in interdisciplinary teams -- cooperate, collaborate, communicate, and integrate in teams to ensure that care is continuous and reliable. • Employ evidence-based practice -- integrate best research with clinical expertise and patient values for optimum care, and participate in learning and research activities to the extent feasible. • Apply quality improvement -- identify errors and hazards in care; understand and implement basic safety design principles, such as standardization and simplification; continually understand and measure quality of care in terms of structure, process, and outcomes in relation to patient and community needs; and design and test interventions to change processes and systems of care, with the objective of improving quality. • Utilize informatics -- communicate, manage knowledge, mitigate error, and support decision making using information technology. To advance the IOM vision, the Committee called on “leaders across the professions to work together on the cross-cutting changes that must occur to effect reform in clinical education and related training environments.” (2) Furthermore, the Committee recommended integrating a core set of competencies – competencies shared across the professions – into the health professions oversight spectrum (state and federal licensure and regulatory bodies and private accreditation and certification entities) that would provide the most leverage in terms of reform for health professions education.(3) The IOM report listed ten (10) different recommendations to achieve the foregoing vision and goals including: 1• An interdisciplinary effort to develop and adopt a common language, with the ultimate aim of achieving consensus across the health professions on a core set of competencies that includes patient-centered care, interdisciplinary teams, evidence-based practice, quality improvement and informatics. 2• A recommendation that DHHS should provide a forum and support for a series of meetings involving a spectrum of oversight organizations across and within disciplines charging attendees with developing the necessary strategies for incorporating a core set of competencies into oversight activities, based on definitions shared across the professions following consultations with health profession associations and the education community. 3• A recommendation that accreditation bodies should move forward expeditiously to revise their standards so that programs are required to demonstrate – through process and outcome measures – that they educate students in both academic and continuing education programs in how to deliver patient care using a core set of competencies.. In doing so, these bodies should coordinate their efforts. 4• All health professions boards should move toward requiring licensed health professionals to demonstrate periodically their ability to deliver patient care – as defined by the five competencies identified by the committee – through direct measures of technical competence, patient assessment, evaluation of patient outcomes, and other evidence-based assessment methods. These boards should simultaneously evaluate the difference assessment methods. 5• Certification bodies should require their certificate holders to maintain their competence throughout the course of their careers by periodically demonstrating their ability to deliver patient care that reflects the five competencies, among other requirements. 6• Foundations, with support from education and practice organizations, should take the lead in developing and funding regional demonstration learning centers, representing partnerships between practice and education. These centers should leverage existing innovative organizations and be state-of-the-art training settings focused on teaching and assessing the five core competencies. 7• Through Medicare demonstration projects, the Centers for Medicare and Medicaid Services (CMS) should take the lead in funding experiments that will 3enable and create incentives for health professionals to integrate interdisciplinary approaches into educational or practice settings, with the goal of providing a training ground for students and clinicians that incorporates the five core competencies. 8• The Agency for Healthcare Research and Quality (AHRQ) and private foundations should support ongoing research projects addressing the vie core competencies and their association with individual and population health, as well as research related to the link between the competencies and evidence-based education. Such projects should involve researchers across two or more disciplines. 9• AHRQ should work with a representative group of health care leaders to develop measures reflecting the core set of competencies, set national goals for improvement, and issue a report to the public evaluating progress toward these goals. AHRQ should issue the first report, focused on clinical educational institutions, in 2005 and produce annual reports thereafter. 10• Beginning in 2004 , a biennial interdisciplinary summit should be held involving health care leaders in education, oversight processes, practice, and other areas. This summit should focus on both reviewing progress against explicit targets and setting goals for the next phase with regard to the five competencies and other areas necessary to prepare professionals for the 21st - century health system. The NYSCA has accepted the proposition that there cannot exist two scientific standards – one for medicine and a separate standard for chiropractic. (4, 5) It is the Association’s goal to be a proactive catalyst for change in the profession by championing professional accountability, promoting clinical and educational excellence, and fostering the development of a multidisciplinary/interdisciplinary team approach to the treatment of common neuromusculoskeletal conditions using evidence-based outcomes measures, best practices, and scientifically-based, multidisciplinary treatment guidelines derived by consensus processes. Fortuitously, the profession is working on the next generation of evidence-based chiropractic practice parameters and best practices through the efforts of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) Committee underwritten by the Congress of Chiropractic State Associations (COCSA). But the profession must also be a participant in the ongoing IOM/National Academies efforts to transform healthcare and healthcare education along the principles noted above. To address these issues and more, the NYSCA has enlisted the following speakers who will examine chiropractic’s role in an integrated healthcare system; the steps the profession would need to take in order to bring about chiropractic’s participation in multidisciplinary/interdisciplinary endeavors, including the integration of the profession with the mainstream healthcare. These persons represent some of the most knowledgeable individuals and strategic elites in chiropractic and the health care system. Strategic Elite # Lewis J. Bazakos, MS, DC earned his chiropractic qualifications from the New York Chiropractic College in 1978, a Master of Science Degree from the University at Bridgeport in 1980 and his baccalaureate degree from St. John’s University in 1975. He is a former Board Member, Treasurer, Vice President, and Past President of the New York State Chiropractic Association and served as a District Officer in NYSCA District 6 and represented District 6 in the NYSCA House of Delegates and served on several NYSCA committees, particularly the NYSCA Legislative Committee. After completing his service with the NYSCA, Dr. Bazakos served as District 1 Governor of the Congress of Chiropractic State Associations (COCSA) for two years. He started serving as a delegate to the American Chiropractic Association (ACA) House of Delegates in 1991 and was elected as a Governor on the ACA Board of Governors three years ago. For the last year and a half, Dr. Bazakos has been a member of the ACA Executive Committee and is slated to be the next Chair of the ACA Board of Governors. Throughout his tenure at ACA, Dr. Bazakos has served the ACA in a variety of capacities but most notably as chair of the ACA Legislative Committee. In 1997, Dr. Bazakos filled the Alumni seat on the Board of Trustees of the New York Chiropractic College. Subsequent to his initial appointment, Dr. Bazakos has co-chaired the NYCC Board of Trustees. He is the current chair of the College Advancement Committee. Strategic Elite # Mark R. Chassin, MD, MPH, MPP, is the Edmond A Guggenheim Professor of Health Policy and Chair of the Department of Health Policy at the Mount Sinai School of Medicine. He is also Senior Vice-President for Clinical Quality at the Mount Sinai Medical Center in New York City. Dr. Chassin received his undergraduate and medical degrees from Harvard University and a master's degree in public policy from the Kennedy School of Government at Harvard. He received a master's degree in public health from the University of California at Los Angeles. Dr. Chassin is a former Commissioner of Health in New York under Governor Mario Cuomo. Dr. Chassin has also served as a senior project director at the RAND Corporation, where he led several major health services research studies and participated as co-investigator in several others including the 1991 series of RAND studies on the “Appropriateness of Spinal Manipulation for Low Back Pain. He was a co-investigator for the 1992 meta-analysis on “Spinal manipulation for low back pain” study that appeared in the Annals of Internal Medicine (October 1992). He was Senior Vice President and Co-Founder of Value Health Sciences, a private sector firm that developed software and systems for quality assessment and utilization review; and Deputy Director and Medical Director of the Office of Professional Standards Review Organizations of the Health Care Financing Administration. Dr Chassin is a renowned expert in the area of performance measurement, clinical indicators and continuous quality improvement. In 2001, he was recognized for his contributions to the fields of quality measurement and improvement with several honors. He was in the first group honored with a lifetime membership of the National Associates of the National Academies, a new program of the National Academy of Sciences. He also received the Founders' Award of the American College of Medical Quality and the Ellwood Individual Award from the Foundation for Accountability. Recently, Dr. Chassin co-chaired the IOM Quality Health Care in America Committee, which issued two reports, in the IOM Quality Chasm Series, “To Err Is Human: Building a Safer Health System released in 1999, and “Crossing the Quality Chasm: A New Health System for the 21st Century,” released in 2001. This committee was responsible for laying the groundwork that lead to the Institute’s call for a dramatic change in the way the health care providers are trained and the way the health care system functions and operates. Dr. Chassin is a member of the Board of Directors of the National Committee for Quality Assurance (NCQA) and the Association for Health Services Research (AHSR). Strategic Elite # Cynthia Laks is the Executive Secretary of the New York State Board for Chiropractic, Office of the Professions, State University of New York, New York State Education Department (SED) in Albany. She was appointed by the Board of Regents to be the Executive Secretary for the NYS Board for Chiropractic on March 1, 2003. In addition to administering the State Board, she also is responsible for reviewing all curricula of foreign professional schools and all endorsement requests for licensure; developing regulations for the chiropractic profession; participating in program registration; coordinating and monitoring disciplinary proceedings; and providing information to the Board, the Department and the public. Secretary Laks received her Master of Arts from Columbia University Teachers College, her Bachelor of Science from New York University and has taken advanced post-graduate credits in public administration at the Nelson A. Rockefeller College of Public Affairs and Policy and Russell Sage Graduate School. Not surprisingly, Secretary Laks has been intimately involved with the State Board, the State Associations and New York Chiropractic College in coordinating the development of the regulations governing mandatory continuing education for chiropractors in New York State. She was also responsible for the oversight and management of the revisions to the Guide to Chiropractic, the Application Packet for Licensure and the Office of the Professions (OP) website dedicated to chiropractic. In addition to her Executive Secretary responsibilities, Ms. Laks is also the legislative coordinator for the Office of the Professions, coordinating legislative comments provided in response to a multitude of bills that affect the 44 licensed professions under the authority of the Board of Regents. She also organizes and contributes to meetings with legislators, lobbyists and professional organization leaders. Most of the members of the State Boards know her best as the primary coordinator of the Board Member Discipline Seminars as well as the Discipline Process Resource Guide. She also has been a lead person in implementing improvements to the professional discipline hearing process and coordinates the scheduling of all first-time hearing dates for the professions. Before coming to the Office of the Professions in 1997, Secretary Laks was the Chief of the Bureau of Continuing Education Program Development within the Office of Elementary, Middle, Secondary and Continuing Education. Strategic Elite # Dana Lawrence, DC is an Associate Professor at the Palmer Center for Chiropractic Research, Palmer College of Chiropractic. Dr. Lawrence earned his chiropractic degree from the National College of Chiropractic, a Bachelor of Science Degree from Michigan State University and a Bachelor of Science Degree in Human Biology also from National. He is licensed to practice chiropractic in Illinois, Michigan and Iowa. Dr. Lawrence is the former Professor in the Department of Chiropractic Practice a post he held from 1987 through 2003 at the National College of Chiropractic and he served in a variety of posts at National for more than twenty-five (25) years. For the last 17 years, Dr. Lawrence has been the editor of the Journal of Manipulative and Physiological Therapeutics (JMPT), and Associate editor of JMPT two years prior to that. JMPT is the only chiropractic journal to be indexed in Index Medicus maintained by the National Library of Medicine, Current Contents/Clinical Medicine, and other international databases as well. Dr. Lawrence also edits the Journal of Chiropractic Medicine and the Journal of Chiropractic Humanities. He also held the post of Director/Associate Director of the National College Department of Editorial Review and Publication from 1986 through 2003. Dr. Lawrence is a past member of the Alternative Medicine Program Advisory Council of the Office of Alternative Medicine (OAM) and the National Center for Complementary and Alternative Medicine (NCCAM). He was responsible for drafting the chiropractic entry in “Alternative Medicine: Expanding Medical Horizons.” In 1998, Dr. Lawrence was honored as “Researcher of the Year” by the Foundation for Chiropractic Education and Research (FCER) in 1998. He received numerous faculty awards while at National College, including several Professor of the Year Awards from National students. Dr. Lawrence also received a Distinguished Service Award from the American Chiropractic Association. Over the years, Dr. Lawrence has served as a consultant to more than 75 entities including stints as peer reviewer and editorial advisory board member to the Journal of Allied Health, Clinical Chiropractic, Journal of the American Chiropractic Association, Topics in Clinical Chiropractic, the Back Pain Society, The Back Letter, the Journal of the Neuromusculoskeletal System, the Journal of Chiropractic Technique, The Chiropractic Report and the Journal of Back and Musculoskeletal Rehabilitation. As editor of JMPT, Dr. Lawrence is affiliated with the World Association of Medical Editors, the Association for Continuing Higher Education, the Hastings Center for Biomedical Ethics, the Council of Science Editors, the American Medical Writer’s Association, and the Society for Scholarly Publishing. Dr. Lawrence has written or co-authored more than 80 papers and 14 book chapters and several books. Strategic Elite # Frank Nicchi, MS, DC earned his chiropractic degree from the New York Chiropractic College (NYCC) in 1978, a Master of Science Degree from the Roberts Wesleyan College, and a Bachelor of Arts Degree from the St. John’s University in 1973. Dr. Nicchi served as the Dean of Postgraduate and Continuing Education at NYCC for five of his nearly twenty-five years of services to NYCC just prior to ascending to the post of President of the College in September 2000. Since 1980, Dr. Nicchi has been an instructor at NYCC in clinical sciences and technique, and as a clinician at the college's Levittown outpatient facility. He was a member of the New York State Chiropractic Association (NYSCA), and served on the NYSCA Board of Directors from 1984-1988. Presently, Dr. Nicchi serves on the Board of Directors of the Association of Chiropractic College’s. Dr. Nicchi was an influential advocate for promoting New York State legislation in areas such as diagnostic and laboratory testing by chiropractors. More recently, as a representative of New York Chiropractic College, he has encouraged legislation for mandatory continuing education for chiropractors, and equality of education requirements for chiropractors to obtain certification status in acupuncture. Dr. Nicchi has presented at numerous chiropractic meetings, state conventions, and interdisciplinary venues on topics ranging from chiropractic management of clinical conditions to chiropractic's role in the health care system. Strategic Elite # Stephen Perle, MS, DC earned his chiropractic degree from the Texas College of Chiropractic, a Masters of Science Degree in Exercise Science from the Southern Connecticut State University and Bachelor Degrees in Biology from Excelsior College in Albany, Cellular & Molecular Biology from the University at Buffalo, and Biomedical Electrical Engineering from the Rensselaer Polytechnic Institute. He is licensed to practice chiropractic in the states of Connecticut, California and New York. He is a Certified Chiropractic Sports Physician, certified by The American Chiropractic Board of Sports Physicians. Dr. Perle is a Associate Professor of Clinical Sciences in the College of Chiropractic, a post he has held since 1991. He is also Adjunct Professor of Mechanical Engineering in the School of Engineering at the University of Bridgeport, Bridgeport, Connecticut. Dr. Perle is the first chiropractor in the United States to receive a tenure-tracked appointment from a university to teach chiropractic. Dr. Perle serves on the steering committee of the University of Bridgeport Institute for the Study of Values and Ethics and is chair of the University’s Institutional Review Board. He also serves on the post-graduate faculty or adjunct faculty at the Southern California Health Sciences University, the Royal Melbourne Institute of Technology, the Texas Chiropractic College, the New York Chiropractic College and the Northwestern College of Chiropractic. He serves as on the editorial boards of the American Running and Fitness Association’s Running & FitNews Training & Conditioning; the Journal of Sports Chiropractic and Rehabilitation and Chiropractic Sports Medicine. He was the principal investigator or co-investigator on several federally funded research grants and has authored/co-authored more than thirty articles in trade publications more than six book chapters. In the course of his career, Dr. Lawrence has presented more than 32 times in different convocations and venues. He is a regular consultant to the State of Connecticut, Department of Public Health, Division of Health Systems Regulation. He also served, as did Dr. Triano, as an Expert Panel Member to the NYSCA Long Range Planning Committee for the Profession, in September 2002. He also served the NYSCA as a former District officer and delegate in the NYSCA House of Delegates. Strategic Elite # Gregory Stewart, DC earned his doctor of chiropractic degree in 1986 from the Canadian Memorial Chiropractic College in Toronto, Ontario, Canada and a Bachelor’s Degree in Physical Education in 1982 from the University of Manitoba, Winnipeg, Manitoba. Dr. Stewart is licensed to practice chiropractic in Manitoba and Ontario. Presently, Dr. Stewart is Chairman of the Canadian Chiropractic Association. He served as President of the Canadian Chiropractic Association from 2002-2003, as a member of the CCA Board of Governors from 1997-1999; as President of the Manitoba Chiropractors’s Association from 1994-1992 and a member of the Manitoba Chiropractor’s Association Board of Directors from 1992 - 1997. Dr. Stewart is a member of the Manitoba Chiropractor’s Association; the Canadian Chiropractic Association, the Canadian Memorial Chiropractic College and the American Back Society. Dr. Stewart also is a professional service provider in Canada providing chiropractic treatment to Canadian Sports Centers, Manitoba 1999 - present; Athletics Canada 1999 Canadian Senior Championships; and Pan-American Games 1999. He is a co-participant with NYSCA President, E. Daniel Quatro on the World Chiropractic Federation Task Fore on chiropractic’s Professional Identity. It is the NYSCA’s understanding that the Canadian Chiropractic Association (CCA) which recently completed an extensive identity/branding process relative to the role of chiropractic in the Canadian healthcare system and the integration of chiropractic into the mainstream of healthcare in Canada. He was selected to be a participant of a 40-member Task Force representing the North American Region, Canadian chapter, assembled by the Toronto-based, World Chiropractic Federation. He was presented with a Distinguished Service Award from the Manitoba Chiropractor’s Association in 2003 as well as a Presidential Citation for Outstanding Service from the Ontario Chiropractic Association 2003. He has made several presentations – World Federation of Chiropractic, Orlando 2003 and a Presentation to Romanow Commission on the Future of Health Care in Canada Winnipeg, 2002. He represented the Canadian Chiropractic Association in the Public Policy Forum Ottawa, 2002 and at World Federation of Chiropractic Conference On the Identity of the Profession, San Francisco, 2004. And he was a speaker at the Occupational Health and Safety Conference, Winnipeg, 2004. Dr. Stewart practices in Winnipeg, Manitoba. Strategic Elite # John J. Triano, DC, PhD is the Co-Director of Conservative Medicine and Director of the Chiropractic Division at the Texas Back Institute, a multidisciplinary spine facility with several locations throughout Texas. Dr. Triano received his chiropractic degree from the Logan College of Chiropractic; his Master’s degree from Webster College and his PhD doctoral degree in biomechanics from the University of Michigan. Dr. Triano is a Fellow of the College of Chiropractic Scientists (Canada) and serves as an editorial advisor to the Journal of Manipulative and Physiological Therapeutics, Spine, The Spine Journal, The BackLetter, and the Journal of the Canadian Chiropractic Association. Dr. Triano is Research Professor in the Department of Engineering, Biomedical Engineering Program at the University of Texas in Arlington, and is an Associate Professor of Biomechanics at the Southwestern School of Medicine. To date he has authored or co-authored more than 63 scientific and clinical articles and 16 book chapters. He was one of two chiropractors who participated in the development of the Agency for Health Care Policy and Research (AHCPR) Guidelines released in 1994 on the treatment of Acute Low Back in Adults. He is the recipient of numerous awards and honors, including ICA Researcher of the Year (1987), FCER Researcher of the Year (1989), AHCPR Service Award (1993), ACA Council on Rehabilitation Doctor of the Year Award (1998), the DC Person of the Year (2002) and the ACA Chairman Award (2003). A leading participant in the Guidelines for Chiropractic Quality Assurance and Practice Parameters (GCQAPP also known as the Mercy Guidelines, Triano is currently the Commission Chair of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP). References 1-Ibid. p. 4. 2-Ibid. 3-Angell M, Kassirer JP. [Editorial] Alternative medicine: the risks of untested and unregulated remedies. N Engl J Med 1998 (Sep 17); 339(12): 839-841. 4-Fontanarosa PB, Lundberg GD. [Editorial] Alternative medicine meets science. JAMA 1998 (Nov 11); 280: 1619-1619. To register click on the .PDF file:
