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Care Outcomes for Chiropractic Outpatient Veterans (COCOV): A Qualitative Study with Veteran Stakeholders From a Pilot Trial of Multimodal Chiropractic Care

By |January 18, 2022|Chiropractic Management, Cost-Effectiveness, Veterans|

Care Outcomes for Chiropractic Outpatient Veterans (COCOV): A Qualitative Study with Veteran Stakeholders From a Pilot Trial of Multimodal Chiropractic Care

The Chiro.Org Blog


SOURCE:   Pilot Feasibility Stud 2022 (Jan 14); 8 (1): 6

Stacie A. Salsbury, Elissa Twist, Robert B. Wallace, Robert D. Vining, Christine M. Goertz & Cynthia R. Long

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
741 Brady Street,
Davenport, Iowa, 52803, USA.



Background:   Low back pain (LBP) is common among military veterans seeking treatment in Department of Veterans Affairs (VA) healthcare facilities. As chiropractic services within VA expand, well-designed pragmatic trials and implementation studies are needed to assess clinical effectiveness and program uptake. This study evaluated veteran stakeholder perceptions of the feasibility and acceptability of care delivery and research processes in a pilot trial of multimodal chiropractic care for chronic LBP.

Methods:   The qualitative study was completed within a mixed-method, single-arm, pragmatic, pilot clinical trial of chiropractic care for LBP conducted in VA chiropractic clinics. Study coordinators completed semi-structured, in person or telephone interviews with veterans near the end of the 10–week trial. Interviews were audiorecorded and transcribed verbatim. Qualitative content analysis using a directed approach explored salient themes related to trial implementation and delivery of chiropractic services.

Results:   Of 40 participants, 24 completed interviews (60% response; 67% male gender; mean age 51.7 years). Overall, participants considered the trial protocol and procedures feasible and reported that the chiropractic care and recruitment methods were acceptable. Findings were organized into 4 domains, 10 themes, and 21 subthemes. Chiropractic service delivery domain encompassed 3 themes/8 subthemes: scheduling process (limited clinic hours, scheduling future appointments, attendance barriers); treatment frequency (treatment sufficient for LBP complaint, more/less frequent treatments); and chiropractic clinic considerations (hire more chiropractors, including female chiropractors; chiropractic clinic environment; patient-centered treatment visits). Outcome measures domain comprised 3 themes/4 subthemes: questionnaire burden (low burden vs. time-consuming or repetitive); relevance (items relevant for LBP study); and timing and individualization of measures (questionnaire timing relative to symptoms, personalized approach to outcomes measures). The online data collection domain included 2 themes/4 subthemes: user concerns (little difficulty vs. form challenges, required computer skills); and technology issues (computer/internet access, junk mail). Clinical trial planning domain included 2 themes/5 subthemes: participant recruitment (altruistic service by veterans, awareness of chiropractic availability, financial compensation); and communication methods (preferences, potential barriers).

There is more like this @ our:

LOW BACK PAIN Section and the:

COST-EFFECTIVENESS Section and the:

CHIROPRACTIC CARE FOR VETERANS Section

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Long-Term Medicare Costs Associated With Opioid Analgesic Therapy vs Spinal Manipulative Therapy for Chronic Low Back Pain in a Cohort of Older Adults

By |December 23, 2021|Cost-Effectiveness, Low Back Pain, Medicare|

Long-Term Medicare Costs Associated With Opioid Analgesic Therapy vs Spinal Manipulative Therapy for Chronic Low Back Pain in a Cohort of Older Adults

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther 2021 (Dec 5)

James M. Whedon, DC, MSm Anupama Kizhakkeveettil, PhD, Andrew Toler, MS, Todd A. MacKenzie, PhD, Jon D. Lurie, MD, MS, Serena Bezdjian, PhD, Scott Haldeman, DC, MD, PhD, Eric Hurwitz, DC, PhD, Ian Coulter, PhD

Health Services Research,
Southern California University of Health Sciences,
Whittier, California.


FROM:   The Facts on Medicare Spending (2019)


Objectives:   The purpose of this study was to compare Medicare healthcare expenditures for patients who received long-term treatment of chronic low back pain (cLBP) with either opioid analgesic therapy (OAT) or spinal manipulative therapy (SMT).

Methods:   We conducted a retrospective observational study using a cohort design for analysis of Medicare claims data. The study population included Medicare beneficiaries enrolled under Medicare Parts A, B, and D from 2012 through 2016. We assembled cohorts of patients who received long-term management of cLBP with OAT or SMT (such as delivered by chiropractic or osteopathic practitioners) and evaluated the comparative effect of OAT vs SMT upon expenditures, using multivariable regression to control for beneficiary characteristics and measures of health status, and propensity score weighting and binning to account for selection bias.

Results:   The study sample totaled 28,160 participants, of whom 77% initiated long-term care of cLBP with OAT, and 23% initiated care with SMT. For care of low back pain specifically, average long-term costs for patients who initiated care with OAT were 58% lower than those who initiated care with SMT. However, overall long-term healthcare expenditures under Medicare were 1.87 times higher for patients who initiated care via OAT compared with those initiated care with SMT (95% CI 1.65-2.11; P < .0001).

There is more like this @ our:

MEDICARE Section and our:

COST-EFFECTIVENESS Section

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The Effect of Reduced Access to Chiropractic Care on Medical Service Use for Spine Conditions Among Older Adults

By |December 15, 2021|Cost-Effectiveness, Cost-Effectiveness of Chiropractic|

The Effect of Reduced Access to Chiropractic Care on Medical Service Use for Spine Conditions Among Older Adults

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther 2021 (Aug 7)

Matthew Davis, Olga Yakusheva, Haiyin Liu, Brian Anderson, Julie Bynum

University of Michigan,
400 North Ingalls, Room 4347,
Ann Arbor, MI 48109



Objective:   The purpose of this study was to examine the extent to which access to chiropractic care affects medical service use among older adults with spine conditions.

Methods:   We used Medicare claims data to identify a cohort of 39,278 older adult chiropractic care users who relocated during 2010-2014 and thus experienced a change in geographic access to chiropractic care. National Plan and Provider Enumeration System data were used to determine chiropractor per population ratios across the United States. A reduction in access to chiropractic care was defined as decreasing 1 quintile or more in chiropractor per population ratio after relocation. Using a difference-in-difference analysis (before versus after relocation), we compared the use of medical services among those who experienced a reduction in access to chiropractic care versus those who did not.

Results:   Among those who experienced a reduction in access to chiropractic care (versus those who did not), we observed an increase in the rate of visits to primary care physicians for spine conditions (an annual increase of 32.3 visits, 95% CI: 1.4-63.1 per 1,000) and rate of spine surgeries (an annual increase of 5.5 surgeries, 95% CI: 1.3-9.8 per 1,000). Considering the mean cost of a visit to a primary care physician and spine surgery, a reduction in access to chiropractic care was associated with an additional cost of $114,967 per 1,000 beneficiaries on medical services ($391 million nationally).

There are more articles like this @ our:

COST-EFFECTIVENESS Section

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Cost-Efficiency and Effectiveness of Including Doctors of Chiropractic

By |January 7, 2020|Cost-Effectiveness|

Cost-Efficiency and Effectiveness of Including Doctors of Chiropractic to Offer Treatment Under Medicaid: A Critical Appraisal of Missouri Inclusion of Chiropractic Under Missouri Medicaid

The Chiro.Org Blog


SOURCE:   Journal of Chiropractic Humanities 2019 (Dec 10)

John R. McGowan, PhD, Leonard Suiter, DC, FICC

Department of Accounting,
Richard A. Chaifetz School of Business,
Saint Louis University,
St. Louis, Missouri


OBJECTIVES:   The objectives of this study were to critically evaluate the methodology and conclusions of the fiscal notes prepared by the state of Missouri for including doctors of chiropractic (DCs) under Missouri Medicaid and to develop a dynamic scoring model that calculates the savings if DCs were allowed to offer treatment under Missouri Medicaid.

METHODS:   We used a secondary analysis to determine the cost-saving assumptions to be incorporated into a dynamic model. We reviewed the literature on efficiency and effectiveness of DC–delivered care regarding the most reliable assumptions concerning cost savings and utilization. The assumptions for percentage savings from DC–provided care and the avoidance of spinal surgeries were then combined in the dynamic scoring model to determine projected cost savings from adding DCs as covered providers under Missouri Medicaid. The actual cost of opioid abuse in Missouri was then determined as a basis to measure cost savings from adding DC care as an alternative therapy for the management of neck and low back pain.

DISCUSSION:   The Missouri Health Division initially used the static scoring approach to evaluate proposals to cover DC care under Missouri Medicaid. This approach only considers added costs from a legislative change.

There are more articles like this @ our:

Cost-Effectiveness Page and the:

Medicare Information Page

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Cost-effectiveness of Spinal Manipulation, Exercise

By |November 15, 2018|Cost-Effectiveness|

Cost-effectiveness of Spinal Manipulation, Exercise, and Self-management for Spinal Pain Using an Individual Participant Data Meta-analysis Approach: A Study Protocol

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2018; 26: 46

Brent Leininger, Gert Bronfort, Roni Evans, James Hodges, Karen Kuntz and John A. Nyman

Integrative Health & Wellbeing Research Program,
Earl E. Bakken Center for Spirituality & Healing,
University of Minnesota,
420 Delaware St SE,
Minneapolis, MN 55455, USA


Background   Spinal pain is a common and disabling condition with considerable socioeconomic burden. Spine pain management in the United States has gathered increased scrutiny amidst concerns of overutilization of costly and potentially harmful interventions and diagnostic tests. Conservative interventions such as spinal manipulation, exercise and self-management may provide value for the care of spinal pain, but little is known regarding the cost-effectiveness of these interventions in the U.S. Our primary objective for this project is to estimate the incremental cost-effectiveness of spinal manipulation, exercise therapy, and self-management for spinal pain using an individual patient data meta-analysis approach.

Methods/design   We will estimate the incremental cost-effectiveness of spinal manipulation, exercise therapy, and self-management using cost and clinical outcome data collected in eight randomized clinical trials performed in the U.S. Cost-effectiveness will be assessed from both societal and healthcare perspectives using QALYs, pain intensity, and disability as effectiveness measures. The eight randomized clinical trials used similar methods and included different combinations of spinal manipulation, exercise therapy, or self-management for spinal pain. They also collected similar clinical outcome, healthcare utilization, and work productivity data. A two-stage approach to individual patient data meta-analysis will be conducted.

There are more articles like this @ our:

The Cost-Effectiveness of Chiropractic Page and the:

Chiropractic and Spinal Pain Management Page and the:

Exercise and Chiropractic Care Page

(more…)

Health Maintenance Care in Work-Related Low Back Pain

By |August 18, 2017|Cost-Effectiveness, Low Back Pain|

Health Maintenance Care in Work-Related Low Back Pain
and Its Association With Disability Recurrence

The Chiro.Org Blog


SOURCE:   J Occupat Enviro Med 2011 (Apr); 53 (4): 396–404


Manuel Cifuentes, MD, PhD,
Joanna Willetts, MS, and
Radoslaw Wasiak, PhD, MA, MSc

Center for Disability Research
Liberty Mutual Research Institute for Safety
University of Massachusetts Lowell
Hopkinton, Mass


This study is unique in that it was conducted by the Center for Disability Research at the Liberty Mutual Research Institute for Safety AND the University of Massachusetts Lowell, Hopkinton, Mass

Their objective was to compare the occurrences of repeated disability episodes between types of health care providers, who treat claimants with new episodes of work-related low back pain (LBP).   They followed 894 patients over 1-year, using workers’ compensation claims data.

By controlling for demographics and severity, they determined the hazard ratio</i? (HR) for disability recurrence between 3 types of providers:

Physical Therapists (PT),
Physicians (MD), or
Chiropractors (DC)
.

The results are quite interesting:

  • For PTs: HR = 2.0
  • For MDs: HR = 1.6
  • For DCs: HR = 1.0

  • Statistically, this means you are twice as likely to end up disabled if you got your care from a Physical Therapists (PT), rather than from a chiropractor.

    You’re also 60% more likely to be disabled if you choose a Physicians (MD) to manage your care, rather than a chiropractor.

    The authors concluded:

    In work-related nonspecific LBP, the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than with chiropractic services.”

 

OBJECTIVES:   To compare occurrence of repeated disability episodes across types of health care providers who treat claimants with new episodes of work-related low back pain (LBP).

METHOD:   A total of 894 cases followed 1 year using workers’ compensation claims data. Provider types were defined for the initial episode of disability and subsequent episode of health maintenance care.

RESULTS:   Controlling for demographics and severity, the hazard ratio [HR] of disability recurrence for patients of physical therapists (HR = 2.0; 95% confidence interval [CI] = 1.0 to 3.9) or physicians (HR = 1.6; 95% CI = 0.9 to 6.2) was higher than that of chiropractor (referent, HR = 1.0), which was similar to that of the patients non-treated after return to work (HR = 1.2; 95% CI = 0.4 to 3.8).

There are more articles like this @ our:

Low Back Pain and Chiropractic Page
and the:

Cost-Effectiveness of Chiropractic Page

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