Integrative Care

Addressing The Burden Of Spine-Related Disorders Through Integrated Value-Based Care

By Frank M. Painter|February 19, 2025|Cost-Effectiveness of Chiropractic, Integrative Care, Nonpharmacologic Therapies|

Addressing The Burden Of Spine-Related Disorders Through Integrated Value-Based Care

SOURCE: Health Affairs Forefront, February 12, 2025

Ryan Burdick • Christian Péan Sara • Holleran Inga Morken • Christine Goertz

Faculty of Health Sciences,
Ontario Tech University.

Editor’s Note:

This article is the latest in the Health Affairs Forefront series, Accountable Care for Population Health, featuring analysis and discussion of how to understand, design, support, and measure patient-centered, cost-efficient care under the umbrella of accountable care. Readers are encouraged to review the Call for Submissions for this series. We are grateful to Arnold Ventures for their support of this work.

The unsustainable rise of health care costs in the US, coupled with suboptimal health outcomes, is driving both conversation and real action toward value-based care (VBC) models in this country. There is no more low-hanging fruit for this effort than spine-related disorders. Low back and neck pain cost us more than $134 billion annually and continues to rise at a rate more than twice that of overall health spending despite the fact that it is already at or near the top of all direct health care expenditures.

Despite aggressive and often invasive treatment approaches, low back pain remains the leading cause of physical disability worldwide with neck pain not far behind. This divergence between cost and outcomes is driven largely by the sustained use of expensive and ineffective treatments that can lead to more harm than benefit. Overreliance on prescription opioids began in the early 2000s, based on weak evidence suggesting that these medications were safe and effective treatments. In addition, the US maintains a higher rate of surgical interventions, more frequent specialist consultations for initial diagnoses, and consistently higher use of medically unnecessary advanced imaging.

Recognizing the profound impact of spine-related disorders, organizations including the

American College of Physicians, the

Centers for Disease Control and Prevention, the

World Health Organization

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Initial Integration of Chiropractic Services into a Provincially Funded Inner City Community Health Centre: A Program Description

By Frank M. Painter|November 7, 2022|Integrative Care|

Initial Integration of Chiropractic Services into a Provincially Funded Inner City Community Health Centre: A Program Description

The Chiro.Org Blog

SOURCE: J Can Chiropr Assoc 2015 (Dec); 59 (4): 363–372

OPEN ACCESS

Steven R. Passmore, DC, PhDm Audrey Toth, DC, Joel Kanovsky, DC. Gerald Olin, BSc, DC

University of Manitoba,
College of Rehabilitation Sciences;
University of Manitoba,
Faculty of Kinesiology & Recreation Management.

Background: The burden of fees for chiropractic services rendered often falls on the patient and must be provided out-of-pocket regardless of their socioeconomic status and clinical need. Universal healthcare coverage reduces the financial barrier to healthcare utilization, thereby increasing the opportunity for the financially disadvantaged to have access to care. In 2011 the Canadian Province of Manitoba initiated a pilot program providing access to chiropractic care within the Mount Carmel Clinic (MCC), a non-secular, non-profit, inner city community health centre.

Objective: To describe the initial integration of chiropractic services into a publically funded healthcare facility including patient demographics, referral patterns, treatment practices and clinical outcomes.

Method: A retrospective database review of chiropractic consultations in 2011 (N=177) was performed.

Results: The typical patient referred for chiropractic care was a non-working (86%), 47.3 (SD=16.8) year old, who self-identified as Caucasian (52.2%), or Aboriginal (35.8%) and female (68.3%) with a body mass index considered obese at 30.4(SD=7.0). New patient consultations were primarily referrals from other health providers internal to the MCC (71.2%), frequently primary care physicians (76%). Baseline to discharge comparisons of numeric rating scale scores for the cervical, thoracic, lumbar, sacroiliac and extremity regions all exceeded the minimally clinically important difference for reduction in musculoskeletal pain. Improvements occurred over an average of 12.7 (SD=14.3) treatments, and pain reductions were also statistically significant at p<0.05.

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Doctors of Chiropractic Working with or within Integrated Healthcare Delivery Systems: A Scoping Review Protocol

By Frank M. Painter|January 11, 2022|Chiropractic Management, Integrative Care|

Doctors of Chiropractic Working with or within Integrated Healthcare Delivery Systems: A Scoping Review Protocol

The Chiro.Org Blog

SOURCE: BMJ Open 2021 (Jan 25); 11 (1): e043754

Eric J Roseen, Bolanle Aishat Kasali, Kelsey Corcoran, Kelsey Masselli, Lance Laird, Robert B Saper, Daniel P Alford, Ezra Cohen, Anthony Lisi, Steven J Atlas, Jonathan F Bean, Roni Evans, André Bussières

Department of Family Medicine,
Boston University School of Medicine and
Boston Medical Center,
Boston, MA, USA

Introduction: Back and neck pain are the leading causes of disability worldwide. Doctors of chiropractic (DCs) are trained to manage these common conditions and can provide non-pharmacological treatment aligned with international clinical practice guidelines. Although DCs practice in over 90 countries, chiropractic care is rarely available within integrated healthcare delivery systems. A lack of DCs in private practice, particularly in low-income communities, may also limit access to chiropractic care. Improving collaboration between medical providers and community-based DCs, or embedding DCs

Methods and analyses: This scoping review will map studies of DCs working with or within integrated healthcare delivery systems. We will use the recommended six-step approach for scoping reviews. We will search three electronic data bases including Medline, Embase and Web of Science. Two investigators will independently review all titles and abstracts to identify relevant records, screen the full-text articles of potentially admissible records, and systematically extract data from selected articles. We will include studies published in English from 1998 to 2020 describing medical settings that have established formal relationships with community-based DCs (eg, shared medical record) or where DCs practice in medical settings. Data extraction and reporting will be guided by the Proctor Conceptual Model for Implementation Research, which has three domains: clinical intervention, implementation strategies and outcome measurement. Stakeholders from diverse clinical fields will offer feedback on the implications of our findings via a web-based

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Integrating a Multidisciplinary Pain Team

By Frank M. Painter|October 25, 2020|Integrative Care|

Integrating a Multidisciplinary Pain Team and Chiropractic Care in a Community Health Center

The Chiro.Org Blog

SOURCE: Journal of Primary Care & Community Health 2020 (Sep 10) ~ FULL TEXT

Christopher Prater 1, Melissa Tepe 2, Patrick Battaglia 3

Affiliations
1. Washington University School of Medicine, St. Louis, MO, USA.

2. Affinia Healthcare, St. Louis, MO, USA.

3. Logan University, Chesterfield, MO, USA.

Background: Chronic spinal pain is one of the most common diseases in the United States. Underserved patients are most affected, and disproportionately may use opioid medications as they lack access to other therapies. It is therefore important to develop systems to treat spinal pain within the primary medical home.

Methods: We designed a prospective observational pilot study at a community health center to measure the effectiveness of two interventions among an underserved population: a multidisciplinary pain team and chiropractic care. Study outcomes were pain and functional disability measured by the Pain Disability Questionnaire (PDQ), and reduction of opioid dose at baseline and 6–12 months. Multivariate linear regression was used to determine associating factors for change in PDQ scores.

Results: Thirty-five individuals completed baseline and follow-up PDQs from August 2018 to May 2020. Overall, the mean baseline PDQ was 92.4 +/– 6.1 and the mean follow-up PDQ was 81.9 +/– 7.7, resulting in a mean improvement of 10.6 (95% CI 1.2 – –22.3, P = .08). Participants in the chiropractic team (mean change –25.0, P = .01) and those completing the study before COVID-19 (mean change = –22.6, P < .01) were found to have significantly greater improvement at follow-up.

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Chiropractic Integration into Private Sector Medical Facilities

By Frank M. Painter|July 23, 2018|Integrative Care|

Chiropractic Integration into Private Sector Medical Facilities:
A Multisite Qualitative Case Study

The Chiro.Org Blog

SOURCE: J Altern Complement Med. 2018 (Jul 17) [Epub]

Anthony J. Lisi, DC, Stacie A. Salsbury, PhD, RN, Elissa J. Twist, DC, MS, and Christine M. Goertz, DC, PhD

Pain Research,
Informatics, Multi-Comorbidities and Education Center,
VA Connecticut Healthcare System,
West Haven, CT.

OBJECTIVES: Chiropractic care may have value in improving patient outcomes and decreasing opioid use, but little is known about the impetus for or process of incorporating these services into conventional medical settings. The purpose of this qualitative study was to describe organizational structures, care processes, and perceived value of chiropractic integration within U.S. private sector medical facilities.

DESIGN: Multisite, comparative organizational case study.

SETTINGS: Nine U.S. private sector medical facilities with on-site chiropractic care, including five hospitals and four clinics.

PARTICIPANTS: One hundred and thirty-five key facility stakeholders including doctors of chiropractic (DCs), non-DC clinicians, support staff, administrators, and patients.

METHODS: Researchers conducted 2-day site visits to all settings. Qualitative data were collected from audio-recorded, semi-structured, role-specified, individual interviews; standardized organizational data tables; and archival document review. A three-member, interdisciplinary team conducted thematic content analysis of verbatim transcripts using an existing conceptual framework and emergent codes.

RESULTS: These nine medical facilities had unique organizational structures and reasons for initiating chiropractic care in their settings. Across sites, DCs were sought to take an evidence-based approach to patient care, work collaboratively within a multidisciplinary team, engage in interprofessional case management, and adopt organizational mission and values. Chiropractic clinics were implemented within existing human resources, physical plant, information technology, and administrative support systems, and often expanded over time to address patient demand. DCs usually were co-located with medical providers and integrated into the collaborative management of patients with musculoskeletal and co-morbid conditions. Delivery of chiropractic services was perceived to have high value among patients, medical providers, and administration. Patient clinical outcomes, patient satisfaction, provider productivity, and cost offset were identified as markers of clinic success.

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Principles in Integrative Chiropractic

By Frank M. Painter|July 17, 2018|Integrative Care|

Principles in Integrative Chiropractic

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2003 (May); 26 (4): 254–272

J.Michael Menke, DC

Program in Internal Medicine,
University of Arizona,
Tucson 85719, USA.

As the public acceptance of chiropractic continues to grow in the United States, [1-3] the private practice chiropractor may find opportunities for formal inclusion in the fast growing integration of complementary and alternative medicine (CAM) into health care delivery. The ability of chiropractors to respond confidently to integration into the overall health care system may be the next step in gaining access to more patients and improving the health care quality.

This necessity for chiropractors to become part of the evolving health care system and still maintain a strong chiropractic identity will be essential, since chiropractic’s value lies in cultivating and delivering the very elements that have made it so high in patient satisfaction: emphasis on biomechanics, manual therapy of the spine, good patient rapport, and strong patient-physician bond. [4, 5] However, there are several barriers to integration: consumer, medical, and chiropractic itself.

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Integrative Care

Addressing The Burden Of Spine-Related Disorders Through Integrated Value-Based Care

Addressing The Burden Of Spine-Related Disorders Through Integrated Value-Based Care

Initial Integration of Chiropractic Services into a Provincially Funded Inner City Community Health Centre: A Program Description

Initial Integration of Chiropractic Services into a Provincially Funded Inner City Community Health Centre: A Program Description

Doctors of Chiropractic Working with or within Integrated Healthcare Delivery Systems: A Scoping Review Protocol

Doctors of Chiropractic Working with or within Integrated Healthcare Delivery Systems: A Scoping Review Protocol

Integrating a Multidisciplinary Pain Team

Integrating a Multidisciplinary Pain Team and Chiropractic Care in a Community Health Center

Chiropractic Integration into Private Sector Medical Facilities

Chiropractic Integration into Private Sector Medical Facilities: A Multisite Qualitative Case Study

Principles in Integrative Chiropractic

Principles in Integrative Chiropractic

Chiropractic Integration into Private Sector Medical Facilities:
A Multisite Qualitative Case Study