Variations in the Implementation and Characteristics of Chiropractic Services in VA
Variations in the Implementation and Characteristics of Chiropractic Services in VA
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DOI：
10.1097/mlr.0000000000000235
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发表时间：
2014-12-01
期刊：
影响因子：
3
通讯作者：
Mittman, Brian S.
中科院分区：
文献类型：
--
作者：
Lisi, Anthony J.;Khorsan, Raheleh;Mittman, Brian S.
背景：2004 年，美国退伍军人事务部通过在全国选定的机构建立现场脊椎按摩诊所，扩大了脊椎按摩治疗服务的范围。缺乏关于这些诊所的规划和实施以及描述其特征和绩效的系统信息。目标：记录 VA 脊椎按摩诊所的规划、实施、主要特征和绩效，并确定变化及其根本原因和关键后果，以及它们对将新临床服务引入综合医疗保健服务系统的政策、实践和研究的影响。研究设计、方法和主题：对 7 家诊所进行比较案例研究，涉及实地访问和电话采访118 个主要利益相关者，包括 VA 临床医生、临床领导和行政人员以及选定的外部利益相关者，以及对有关诊所绩效和服务交付的关键文件和管理数据的审查。使用归纳（探索性）和演绎混合的方法对访谈进行记录、转录和分析。结果和结论：访谈数据揭示了临床规划和实施过程、临床特征以及对临床表现和质量的看法存在相当大的差异。管理数据显示，随着时间的推移，诊所患者护理量的模式存在很大差异。机构建立脊椎按摩诊所的最初意愿，以及机构脊椎按摩师更高程度的循证属性和合议属性，成为与提供更高、更一致的脊椎按摩服务以及更高的服务质量相关的关键因素。
Background: In 2004, the US Department of Veterans Affairs expanded its delivery of chiropractic care by establishing onsite chiropractic clinics at select facilities across the country. Systematic information regarding the planning and implementation of these clinics and describing their features and performance is lacking.Objectives: To document the planning, implementation, key features and performance of VA chiropractic clinics, and to identify variations and their underlying causes and key consequences as well as their implications for policy, practice, and research on the introduction of new clinical services into integrated health care delivery systems.Research Design, Methods, and Subjects: Comparative case study of 7 clinics involving site visit-based and telephone-based interviews with 118 key stakeholders, including VA clinicians, clinical leaders and administrative staff, and selected external stakeholders, as well as reviews of key documents and administrative data on clinic performance and service delivery. Interviews were recorded, transcribed, and analyzed using a mixed inductive (exploratory) and deductive approach.Results and Conclusions: Interview data revealed considerable variations in clinic planning and implementation processes and clinic features, as well as perceptions of clinic performance and quality. Administrative data showed high variation in patterns of clinic patient care volume over time. A facility's initial willingness to establish a chiropractic clinic, along with a higher degree of perceived evidence-based and collegial attributes of the facility chiropractor, emerged as key factors associated with higher and more consistent delivery of chiropractic services and higher perceived quality of those services.