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，以实现他在CAM研究领域的职业目标。获得的技能将应用于三个特定的目标，即在美国老年人中使用脊椎指压疗法的安全性。对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，该环境因在卫生政策研究中利用此类数据而闻名于世。Specific Aim #1将使用回顾性队列设计和描述性分析来检查65岁以上成年人脊椎指压治疗的可用性、利用率和成本的地理差异。预计这些数据将为卫生保健政策决策提供有用的见解，正如达特茅斯卫生政策和临床实践研究所（TDI）的利用研究历来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性问题。随着越来越多的老年人使用脊椎按摩服务，安全问题变得越来越重要。具体目标#2将评估65岁以上成人脊椎指压疗法后中风和某些中风亚型的发生率。本研究将确定与脊椎指压治疗相关的中风风险，并将结果与其他类型提供者的中风风险进行比较。具体目标#3将评估65岁以上的成年人在脊椎指压治疗后头部、颈部和躯干特定损伤的风险，再次与其他类型的提供者进行比较。分析还将评估损伤与被认为是脊椎指压疗法禁忌症的既往疾病之间的关系。在这个为期五年的项目结束时，将包括在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. 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.