THE AVAILABILITY OF CHIROPRACTIC CARE AND USE OF HEALTH SERVICES FOR BACK PAIN

脊椎按摩治疗的可用性和背痛健康服务的使用

• 批准号: 9187422
• 负责人: Matthew A Davis
• 金额: $ 35.11万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-12-01 至 2019-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9187422
• 关键词: Address; Adult; Affect; American; Area; Automobile Driving; Back Pain; Caring; Chiropractor; Chronic; Chronic Disease; Clinical Management; Complementary and alternative medicine; Data; Dependency; Diabetes Mellitus; Diagnostic Imaging; Direct Costs; Elderly; Emergency department visit; Etiology; Expenditure; Geographic Information Systems; Goals; Health; Health Care Costs; Health Services; Healthcare; Healthcare Systems; Knowledge; Link; Location; Lung diseases; Measures; Medical; Medicare; Methods; Mission; Myocardial Ischemia; National Health Insurance; Natural experiment; Neck Pain; Opioid Analgesics; Pain management; Pathologic; Pathology; Pathway interactions; Patients; Physicians; Population; Practice Guidelines; Primary Care Physician; Primary Health Care; Provider; Public Health; Research; Research Design; Research Project Grants; Services; Symptoms; System; Testing; Time; United States National Institutes of Health; Vertebral column; Visit; Work; chiropracty; cost; disability; health care service utilization; health service use; innovation; medical specialties; novel; public health relevance; tool

 DESCRIPTION (provided by applicant): Back pain is among the top contributors to disability among Americans and is associated with considerable cost to the US economy. Despite established practice guidelines that recommend conservative approaches, clinical management of nonspecific back pain (i.e., back pain that is not caused by pathologic etiology) varies, with evidence of overuse of opioid analgesics, early diagnostic imaging, and specialty care. Older adults in particular receive poorer care for nonspecific back pain than their younger counterparts. While nonspecific back pain is one of the top reasons adults visit physicians, it also happens to be one of the most common conditions treated by complementary and alternative medicine (CAM) providers who rely on conservative management. In the US, the chiropractic profession is the largest and most organized CAM group, and chiropractic care is the only CAM service covered by Medicare. However, current information available to health policymakers lacks a fundamental understanding of the potential indirect effects of chiropractic care in Medicare. The overall objective of this project is to rigorously examine the relationship between availability of chiropractic care and utilization, expenditures, and care for nonspecific back pain. Our central hypothesis is that chiropractic care is being used as a substitute for ambulatory medical services and affects both expenditures and nonspecific back pain care. This research project has the following two aims: (1) Among older adults, determine the extent to which availability of chiropractic care influences use of and expenditures on ambulatory medical services (e.g., primary care, specialty care, and emergency room visits) for nonspecific back pain and (2) Among older adults, determine the extent to which availability of chiropractic care influences clinical management of nonspecific back pain. Our approach is innovative because it departs from the current status quo by performing a real-world, natural experiment using Medicare patients who relocated. As each patient serves as his or her own control, this rigorous study design is better suited to identify causal relationships and will allow us the unique opportunity to observe the effect of a change in chiropractic care availability. In order to measure availability of chiropractic care and other health services, we will apply novel geographic information system (GIS) tools. This proposed project is significant because it will provide timely information for health policymakers to anticipate effects of healthcare system redesign; specifically, how inclusion of a CAM service in a national health insurance system impacts care of older adults with nonspecific back pain.

 描述（由申请人提供）：背痛是美国人残疾的主要原因之一，并与美国经济的相当大的成本有关。尽管已建立的实践指南推荐保守的方法，非特异性背痛的临床管理（即，非病理病因引起的背痛）各不相同，有阿片类镇痛药过度使用、早期诊断成像和专科护理的证据。特别是老年人接受较差的照顾非特异性背痛比年轻的同行。虽然非特异性背痛是成年人就医的主要原因之一，但它也恰好是依赖保守管理的补充和替代医学（CAM）提供者治疗的最常见疾病之一。在美国，脊椎指压治疗专业是最大和最有组织的CAM组，脊椎指压治疗护理是医疗保险覆盖的唯一CAM服务。然而，目前的信息提供给卫生政策制定者缺乏一个基本的理解的潜在的间接影响脊椎按摩治疗在医疗保险。这个项目的总体目标是严格检查脊椎治疗的可用性和利用率，支出和非特异性背痛护理之间的关系。我们的中心假设是，脊椎按摩治疗正在被用作替代门诊医疗服务，并影响支出和非特异性背痛护理。本研究项目有以下两个目的：（1）在老年人中，确定脊椎按摩治疗的可用性在多大程度上影响了门诊医疗服务的使用和支出（例如，初级保健，专科护理和急诊室就诊）的非特异性背痛和（2）在老年人中，确定脊椎按摩治疗的可用性在多大程度上影响非特异性背痛的临床管理。我们的方法是创新的，因为它通过使用重新安置的医疗保险患者进行真实世界的自然实验，脱离了目前的现状。由于每位患者都是自己的对照组，因此这种严格的研究设计更适合于确定因果关系，并将使我们有独特的机会观察脊椎按摩治疗可用性变化的影响。为了衡量脊椎治疗护理和其他卫生服务的可用性，我们将采用新的地理信息系统（GIS）工具。这个拟议的项目是重要的，因为它将为卫生政策制定者提供及时的信息，以预测医疗保健系统重新设计的影响;特别是，如何将CAM服务纳入国家健康保险系统影响非特异性背痛老年人的护理。