Utilization and Safety of Chiropractic Care in Older Adults

描述（由申请人提供）：候选人的目标是获得进一步的教育和培训，以实现他的目标，在CAM研究的职业生涯。所获得的技能将应用于三个具体目标的利用和安全的脊椎按摩在美国老年人。医疗保险索赔数据的大型国家样本的分析将在一个独特的研究环境中进行，该环境在国际上以利用此类数据进行卫生政策研究而闻名。具体目标#1将使用回顾性队列设计和描述性分析，以检查65岁以上成人脊椎按摩可用性，利用率和成本的地理差异。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，因为达特茅斯卫生政策和临床实践研究所（TDI）的利用研究历史上在其他领域已经完成。另外两个目标将使用病例对照设计检查老年患者的安全性问题。随着越来越多的老年人越来越多地使用脊椎指压治疗服务，安全问题变得越来越重要。具体目标#2将评估65岁以上成年人在脊椎推拿治疗后中风和某些中风亚型的发病率。这项研究将确定中风的风险暂时与脊椎按摩治疗，并比较结果与中风的风险后，访问其他类型的供应商。具体目标#3将评估65岁以上成年人接受脊椎推拿治疗后头部、颈部和躯干特定损伤的风险，再次与其他提供者类型的风险进行比较。该分析还将评估损伤与被认为是脊椎推拿禁忌症的预先存在的条件之间的关联。在这个为期五年的项目结束时，将包括TDI严格的正式培训计划以及指导研究，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。 公共卫生相关性：随着医疗保险覆盖人口比例的增加，全面了解CAM护理的资源和提供变得越来越重要。此外，必须认识到老年人并发症的风险。拟议的研究利用TDI开创的现有技术和方法解决这些紧迫问题。

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. PUBLIC HEALTH RELEVANCE: A comprehensive understanding of resources and delivery of CAM care becomes increasingly important as the percentage of the population covered by Medicare increases. Additionally, it is essential to recognize the risk of complications in the elderly. The proposed studies address these pressing issues using established techniques and approaches pioneered at TDI.