Use of chiropractic spinal manipulation in older adults is strongly correlated with supply.
Use of chiropractic spinal manipulation in older adults is strongly correlated with supply.
复制标题
在老年人中使用脊骨疗法操纵与供应密切相关。
DOI：
10.1097/brs.0b013e31825762b7
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发表时间：
2012-09-15
期刊：
影响因子：
3
通讯作者：
Lurie JD
中科院分区：
文献类型：
--
作者：
Whedon JM;Song Y;Davis MA;Lurie JD
行政数据的回顾性横断面分析。研究区域脊椎按摩治疗供应与医疗保险受益人脊椎按摩服务的使用和利用强度之间的关系。许多研究记录了美国脊椎按摩治疗服务利用的趋势和模式，但对于脊椎按摩治疗供应和利用之间关系的地理差异知之甚少。我们分析了 2008 年脊椎按摩医生提供的医疗保险索赔数据。我们将数据汇总到医院转诊区域级别，并采用小区域分析技术来生成描述性统计数据。我们绘制了脊椎按摩疗法供应、使用和利用强度（每个用户的治疗次数）的地理变化，并通过变异系数和极值比率量化了变化。我们采用斯皮尔曼等级相关系数将使用与供应关联起来。我们针对脊椎按摩疗法的使用采用逻辑回归模型，针对脊椎按摩疗法的使用强度采用多元线性回归模型。该地区脊椎按摩医生的平均供应量为每 10 万名成年人中 21.5 名。使用脊椎按摩疗法的受益人的平均百分比约为 7.6 (SD 3.9)。平均利用强度为 10.6 (SD 1.8)。区域脊椎按摩疗法供应量差异超过 14 倍，脊椎按摩疗法使用量差异超过 17 倍。脊椎按摩疗法的供应和使用呈正相关（Spearman’s rho 0.68；p<.001）。腰背或颈椎问题与脊椎按摩疗法的使用密切相关（OR 分别为 21.6 和 14.3）。脊椎按摩疗法供应量的增加与脊椎按摩疗法使用的增加相关（OR 1.04），但与脊椎按摩疗法使用强度的增加无关。脊椎按摩师的供应量和美国老年人对脊椎按摩疗法的利用因地区而异。脊椎按摩疗法供应量的增加与脊椎按摩疗法使用的增加相关，但与脊椎按摩疗法使用强度的增加无关。脊椎按摩疗法的利用可能对供应和患者的偏好都很敏感。
Retrospective cross-sectional analysis of administrative data. To examine the relationship between regional chiropractic supply and both use and utilization intensity of chiropractic services among Medicare beneficiaries. Numerous studies have documented trends and patterns in the utilization of chiropractic services in the United States, but little is known about geographic variation in the relationship between chiropractic supply and utilization. We analyzed Medicare claims data for services provided by chiropractic physicians in 2008. We aggregated the data to the hospital referral region level and employed small area analysis techniques to generate descriptive statistics. We mapped geographic variations in chiropractic supply, use and utilization intensity (treatments per user) and quantified the variation by coefficient of variation and extremal ratio. We employed Spearman’s rank correlation coefficient to correlate use with supply. We employed a logistic regression model for chiropractic use and a multiple linear regression model for chiropractic utilization intensity. The average regional supply of chiropractic physicians was 21.5 per 100,000 adult capita. The average percentage of beneficiaries who used chiropractic was approximately 7.6 (SD 3.9). The average utilization intensity was 10.6 (SD 1.8). Regional chiropractic supply varied more than 14 fold, and chiropractic use varied more than 17 fold. Chiropractic supply and use were positively correlated (Spearman’s rho 0.68; p<.001). A low back or cervical spine problem was strongly associated with chiropractic use (OR 21.6 and 14.3, respectively). Increased chiropractic supply was associated with increased chiropractic use (OR 1.04), but not with increased chiropractic utilization intensity. Both the supply of chiropractors and the utilization of chiropractic by older US adults varied widely by region. Increased chiropractic supply was associated with increased chiropractic use, but not with increased chiropractic utilization intensity. Utilization of chiropractic care is likely sensitive to both supply and patient preference.