Course Notes

A Solid Plan of Care Throughout the Entire Patient Encounter



Course Description:

During this session, Dr. Gwilliam will discuss the use of evidence-informed care guidelines to assist in determining care plans throughout the patient encounter. This webinar will provide the practitioner with methods to enhance everyday practice with correlations from the examination and the literature to derive patient-centered care for optimal healing.



  • Describe characteristics of evidence-informed care and how it impacts clinical decision-making.
  • Discuss short-term and functional goals for patient care and the correlative to patient-centered treatment plans.
  • Summarize patient-centered treatment plans. 





Elements of Treatment Plan

  • A list of each complaint, with its relevant diagnosis (remember to include “due to”)
  • Treatments and modalities selected with rationale
  • How long and often do you see the patient (duration & frequency)
  • What are you trying to accomplish Stages or phases of care (goals)
  • How do you know when you have accomplished the goal (assessments & outcomes)


Best Care Practices

  • Individual Clinical Expertise
  • Best Research Evidence
  • Patient’s Values and Expectations



Descriptions for symptomatic and functional recovery

  • Excellent  2-4 weeks
  • Good  4-8 weeks with possible mild pain and restriction of motion
  • Fair  reduction in symptoms but persistent pain and stiffness from injury is expected and may require ongoing rehab
  • Poor Pre-existing injury causes doubt for full recovery; pain, paresthesia is expected but necessitating palliative care
  • Guarded Not expected to improve in the near future. Continued muscle weakness and sensory deficit. Palliative and Supportive Care warranted for some improvement in function.
  • Unstable Not responded to treatment. Surgery would be advisable.


Complicating Factors that justify additional treatment:

  • Patient Characteristics
  • Injury Characteristics
  • History Characteristics


Short Term & Long Term Goals list them in (1. 2. 3. 4. )

  • Assign a number, measurement and timeframe to each goal that makes it unique to each patient


  • Were goals achieved
  • If not, why?
  • How will the plan of care change to adapt the goals that were not met?


Why A Care Plan Is Important


Compliant Care Plan Examples vs. Treatment Schedule


Stages of Care



Clinical Practice Guideline: Chiropractic Care for Low Back Pain (J Manipulative Physiol Ther. 2016; 39, by Globe G, Farabaugh RJ, Hawk C, Morris CE, Baker G, Whalen WM, Walters S, Kaeser M, Dehen M, Augat T.)

 2018 ChiroCode DeskBook, 26th ed.  Gwilliam et. al.  ChiroCode Inc.

 Medicare Needs Better Controls To Prevent Fraud, Waste, And Abuse Related To Chiropractic Services, An OIG Portfolio, February 2018, A-089-16-02042, U.S. Department of Health and Human Services, Office of Inspector General

 Local Coverage Determination (LCD): Chiropractic Services (L33613), page 6, National Government Services, Inc.

 Local Coverage Determination (LCD): Chiropractic Services (L35424), page 8, Novitas Solutions, Inc.

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