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

 描述(由申请人提供)：背痛是美国人致残的主要原因之一，并与美国经济的相当大成本有关。尽管已建立的实践指南推荐保守的方法，但非特异性背痛(即非由病理原因引起的背痛)的临床处理各不相同，有证据表明过度使用阿片类止痛剂、早期诊断成像和特殊护理。尤其是老年人，与年轻人相比，他们对非特异性背痛的护理更差。虽然非特异性背痛是成年人去看医生的主要原因之一，但它也是依赖保守治疗的补充和替代医学(CAM)提供者治疗的最常见的疾病之一。在美国，脊椎疗法专业是最大和最有组织的CAM群体，而脊椎疗法护理是医疗保险覆盖的唯一CAM服务。然而，卫生政策制定者目前可获得的信息缺乏对脊椎疗法在医疗保险中的潜在间接影响的基本了解。这个项目的总体目标是严格检查脊椎按摩护理的可用性和利用率、支出以及非特异性背痛护理之间的关系。我们的中心假设是，脊椎按摩护理正在被用作非门诊医疗服务的替代品，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标：(1)在老年人中，确定脊椎按摩护理的可用性在多大程度上影响非特异性背痛的门诊医疗服务(例如，初级保健、专科护理和急诊室就诊)的使用和支出；(2)在老年人中，确定脊椎按摩护理的可用性在多大程度上影响非特异性背痛的临床治疗。我们的方法是创新的，因为它通过使用搬迁的联邦医疗保险患者进行真实世界的自然实验来改变目前的现状。由于每个患者都充当他或她自己的对照，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治疗可获得性变化的影响。为了衡量脊椎保健和其他医疗服务的可获得性，我们将应用新的地理信息系统工具。这个拟议的项目意义重大，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；具体地说，将CAM服务纳入国家医疗保险系统将如何影响患有非特异性背痛的老年人的护理。

 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.