Value of Chiropractic Services at an On-site Health Center
Curt A. Krause, DC; Lisa Kaspin, PhD; Kathleen M. Gorman, MPH; Ross M. Miller, MD, MPH
From the Cerner Healthe Clinic (Dr Krause), Kansas City, MO; Cerner LifeSciences Consulting (Dr Kaspinand and Ms Gorman), Beverly Hills, CA; and Cerner Employer Services (Dr Miller), Cerner Corporation, Beverly Hills, CA.
OBJECTIVE: Chiropractic care offered at an on-site health center could reduce the economic and clinical burden of musculoskeletal conditions.
METHODS: A retrospective claims analysis and clinical evaluation were performed to assess the influence of on-site chiropractic services on health care utilization and outcomes.
RESULTS: Patients treated off-site were significantly more likely to have physical therapy (P < 0.0001) and outpatient visits (P < 0.0001). In addition, the average total number of health care visits, radiology procedures, and musculoskeletal medication use per patient with each event were significantly higher for the off-site group (all P < 0.0001). Last, headache, neck pain, and low back pain-functional status improved significantly (all P < 0.0001).
CONCLUSIONS: These results suggest that chiropractic services offered at on-site health centers may promote lower utilization of certain health care services, while improving musculoskeletal function.
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From the FULL TEXT Article:
Although previous research has demonstrated the benefits of chiropractic care, to the best of our knowledge this study is the first to evaluate its impact when offered at an on-site health center. [6–10, 14–17] Given the convenience and quality of care provided by on-site health centers, it was hypothesized that on-site chiropractic care would be more beneficial than off-site clinic care. Despite some limitations that may have weakened the conclusions, the findings suggest on-site chiropractic services are associated with lower health care utilization of certain services and improved functional status of musculoskeletal conditions.
Specifically, patients receiving chiropractic care on-site were less likely to have a physical therapy visit (P < 0.0001) and outpatient visit (P < 0.0001). Moreover, the average total numbers of health care visits, radiology procedures, and musculoskeletal medication use per associate with each event were significantly lower for the on-site group (all P < 0.0001). Metz et al  assessed health plan members with and without chiropractic coverage and found that patients were directly substituting chiropractic care for medical care when it was available. Although all patients in our study had access to chiropractic care, the convenience of having it on-site may have eliminated the access barriers for patients who may have received other types of medical care instead. This trend is most evident in the finding that the on-site group averaged significantly fewer physical therapy and physician visits compared with the off-site group (both P < 0.0001), given that chiropractic care is a common alternative for both of these services. [18, 19]
Lower health care utilization among the on-site group may also be related to the characteristics of effective chiropractic care. On the basis of a large claims analysis, Legorreta et al  reported that chiropractic services were associated with less invasive, more conservative treatments. That is, patients with chiropractic coverage seemed to be avoiding more surgeries, hospitalizations, and radiographic imaging procedures. Similarly, Phelan et al  observed that chiropractic patients had lower utilization of ancillary medical services. In this study, associates who received care on-site were less likely to have an outpatient visit (P < 0.0001), but average utilization among associates who had a visit was similar between groups. This finding suggests that on-site chiropractic care may be lowering the occurrence of outpatient visits among associates on the cusp of requiring these services, but utilization is not affected for more serious cases.