Assessing the importance and feasibility of quality measures for chiropractic care: a national survey of U.S. chiropractors.

backgroundQuality measures (QMs) are evidence-based metrics used to assess health care quality. A preliminary set for chiropractic care was recently developed and subsequently validated using modified Delphi consensus methodology. To prepare for eventual use, this study explored U.S. licensed chiropractors’ perceptions of the importance and feasibility of implementing quality measures in practice settings with distinct characteristics (e.g., single vs. multidisciplinary, portal-of-entry vs. referral access, varying population density regions, and health professional shortage areas).

methodsAn electronic survey of U.S. licensed chiropractors was administered from March-May 2025. We mailed 22,330 postcard invitations and distributed electronic invitations through newsletters and/or social media announcements from chiropractic organizations and institutions. Each respondent rated 31 QMs of clinical processes and outcomes. QMs were rated on the importance of supporting quality care and the feasibility of implementation in respondent settings on a 5-point Likert scale (low to high importance/feasibility). We calculated mean ratings and rank-ordered measures, comparing subgroups differing by setting characteristics. We assessed rank-order correlation with Kendall’s Tau correlation coefficient, and rank-order agreement using Kendall’s W. To ensure results reflected national demographic proportions, responses were weighted on seven demographic variables, and analyses compared between weighted and unweighted data.

resultsEight hundred sixty-nine respondents completed the survey. Respondents were 69% male, with a mean age of 51.4 (SD = 14.3) years and a mean of 23.8 (SD = 14.1) years of experience. For importance ratings, rank-order correlation between subgroups was high (Kendall’s Tau = 0.75 or above) and agreement was unusually strong (Kendall’s W = 0.96). For feasibility ratings, correlation was moderate or higher (Kendall’s Tau = 0.55 or above) and agreement was strong (Kendall’s W = 0.89). ‘Documenting adverse events’ was the highest rated measure for importance with a mean of 4.79 (SD = 0.56) and ‘Performing an exam for a presenting problem’ was the highest rated measure for feasibility with a mean of 4.65 (SD = 0.77). Rank-order correlation and agreement from weighted and unweighted analyses were not appreciably different. Eight of the 10 highest-rated clinical process measures directly or indirectly support patient safety.

conclusionsRatings for importance and feasibility differed little among subgroups defined by population density and health setting characteristics. The high importance ratings for safety-related clinical process measures are consistent with the concept of patient safety as a fundamental component of quality care.