Utilization and Safety of Chiropractic Care in Older Adults

描述(由申请人提供)：应聘者的目标是接受进一步的教育和培训，以实现他在CAM研究领域的职业目标。所获得的技能将应用于有关美国老年人使用脊椎疗法和安全性的三个具体目标。对医疗保险索赔数据的全国大样本的分析将在一个独特的研究环境中进行，该环境以在卫生政策研究中使用此类数据而闻名。具体目标#1将使用回溯性队列设计和描述性分析来检查65岁以上成年人在脊椎疗法可获得性、利用率和费用方面的地理差异。预计这些数据将提供有用的见解，为卫生保健政策决策提供信息，就像达特茅斯卫生政策和临床实践研究所(TDI)历史上在其他领域所做的那样。另外两个目标将使用病例对照设计来检查老年患者的安全问题。随着越来越多的老年人口对脊椎按摩服务的利用，安全问题变得越来越重要。具体目标#2将评估65岁以上成年人脊椎推拿后中风的发生率和某些中风亚型。这项研究将确定与脊椎按摩治疗暂时相关的中风风险，并将结果与访问其他类型的提供者后中风的风险进行比较。具体目标#3将评估65岁以上成年人在脊椎手法治疗后头部、颈部和躯干选定损伤的风险，并再次将其与访问其他类型提供者后的风险进行比较。该分析还将评估损伤与先前存在的被认为是脊椎手法禁忌症的疾病之间的关系。在这个为期五年的项目结束时，该项目将包括在TDI的严格的正式培训计划以及有指导的研究，候选人的目标是获得独立研究调查员的地位，将在该计划中获得的技能应用于CAM疗法的评估。

DESCRIPTION (provided by applicant): The candidate has the objective of obtaining further education and training in order to realize his goal of a career in CAM research. The acquired skills will be applied to three specific aims on the utilization and safety of chiropractic in older U.S adults. The analysis of large national samples of Medicare claims data will take place in a unique research environment that is internationally known for utilizing such data in health policy research. Specific Aim #1 will use a retrospective cohort design with descriptive analysis to examine geographic variations in chiropractic availability, utilization and cost for adults over 65. It is anticipated that these data will provide useful insights to inform health care policy decision making, as utilization studies from The Dartmouth Institute for Health Policy and Clinical Practice (TDI) have historically done in other fields. The other two aims will examine safety issues in older patients, using case-control designs. With growing utilization of chiropractic services by an expanding elderly population, safety issues are becoming increasingly important. Specific Aim #2 will evaluate the incidence of stroke and certain stroke subtypes following chiropractic spinal manipulation among adults over 65. This study will ascertain the risk of stroke temporally associated with chiropractic treatment, and compare the results with the risk of stroke following visits to other types of providers. Specific Aim #3 will evaluate the risk of selected injuries of the head, neck and trunk following chiropractic spinal manipulation in adults over 65, again compared to the risk following visits to other provider types. The analysis will also evaluate associations between injuries and pre-existing conditions that are considered contraindications to chiropractic spinal manipulation. At the end of this five-year project, which will include a rigorous formal training program at TDI as well as mentored research, the candidate's goal is to attain status as an independent research investigator, applying the skills obtained in the program to the evaluation of CAM therapies.