Continuous quality improvement (CQI) is a process to assess what we are doing and how we can do it better. But how is CQI done for osteopathic manipulative care? Traditionally, assessing quality of osteopathic manipulative care was based on the clinician’s posttreatment examinations, patient reports of how they felt immediately after treatment, and patient reports when they returned for followup. Looking at these components more closely, the clinician’s posttreatment palpation assessment evaluates whether the patient feels less pain when painful areas are reexamined and whether the patient’s tissues feel suppler or have more motion or symmetry than before treatment. To ensure quality during this assessment process, the patient would have to be palpated consistently, at the same location, and with similar forces, directions, and durations to make valid comparisons between before and after examinations. Additionally, there can be ambiguity about whether the patient’s immediate reports about the effects of treatment are associated with physiologic changes or arise from attention and other nonspecific factors that occur during treatment. At followup, there is a question about whether patients have accurate recall of their symptoms from the initial visit. Or what can be concluded when no followup occurs? This subjective process of clinician and patient assessment has existed for over a century with the assumption that, over time, feedback improves skills and outcomes, but the veracity of this assumption is clearly limited. In this era of CQI, DO-Touch.NET was established and thrived by promoting science and CQI within osteopathy. Every study in DO-Touch.NET has been designed to progressively improve quality of data collected from clinicians and patients and to assess effectiveness and safety of osteopathic manipulative care. CQI will remain in the forefront of every future network study. As for CQI in osteopathic manipulative healthcare, advanced scientific methods for assessing performance and interpretation of diagnostic and therapeutic palpation have been developed by the A.T. Still Research Institute and incorporated into the Advancing Skills in Osteopathy (ASO) continuing education courses regularly sponsored by DO-Touch.NET. This summer, 3 ASO courses were conducted by DO-Touch.NET for clinicians from 3 continents. Several members have now taken the ASO course more than once as a way to personally perform CQI. So how is CQI done in osteopathic manipulative care in the 21st century? It is done through the programming and research of DO-Touch.NET. Stay on the cutting edge of science and CQI in osteopathic manipulative care by being an active member of DO-Touch.NET!
Brian F. Degenhardt, DO
Director of DO-Touch.NET
Director, A.T. Still Research Institute of ATSU