Utilization and Safety of Chiropractic Care in Older Adults

老年人脊椎按摩疗法的利用和安全性

• 批准号: 8044189
• 负责人: James M. Whedon
• 金额: $ 11.42万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-04-01 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8044189
• 关键词: Address; Adherence; Adult; Affect; Alternative Therapies; Atlases; Back Pain; Caring; Categories; Clinical; Complementary therapies; Data; Decision Making; Disease; Documentation; Effectiveness; Elderly; Environment; Evaluation; Future; Goals; Guidelines; Health; Health Care Reform; Health Insurance; Health Policy; Healthcare; Healthcare Systems; Incidence; Injury; Institutes; Insurance Coverage; Maps; Medical; Medicare; Medicare claim; Mentors; Methods; Modeling; Musculoskeletal; Neck Pain; Operative Surgical Procedures; Patient Preferences; Performance; Policy Maker; Policy Research; Population; Prevalence; Provider; Publications; Relative (related person); Research; Research Personnel; Resources; Risk; Role; Safety; Sampling; Series; Services; Spinal Manipulation; Stroke; System; Techniques; Third-Party Payer; Training Programs; Training and Education; United States; Variant; Visit; base; career; case control; chiropracty; clinical practice; cohort; cost; design; evidence base; geographic difference; head/neck injury; insight; older patient; programs; public health relevance; skills

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.

描述（由申请人提供）：候选人的目的是获得进一步的教育和培训，以实现他在CAM研究中的职业目标。获得的技能将适用于在美国年长的成年人脊椎治疗的三个特定目标。大型国家医疗保险索赔数据的分析将在一个独特的研究环境中进行，该研究环境以卫生政策研究中利用此类数据而闻名。具体目标1将使用回顾性队列设计和描述性分析来检查脊骨疗法可用性，利用率和成人成本的地理差异。预计这些数据将提供有用的见解，以为医疗保健政策决策提供信息，作为Dartmouth Institute for Dartmouth Institute for Health Policy和Clanigal Institute for Health Policy和Clulical Bacelical实践（TDI）（TDI的历史上），这是其他领域（TDI）。其他两个目标将使用病例对照设计检查老年患者的安全问题。随着不断扩大的老年人口对脊椎治疗服务的利用越来越大，安全问题变得越来越重要。具体目的＃2将评估65岁以上成年人脊骨脊髓操纵后的中风的发生率和某些中风亚型的发生率。本研究将确定与脊椎治疗相关的中风风险，并将结果与​​其他类型的提供者访问后的中风风险与中风的风险进行比较。特定的目标＃3将评估65岁以上的成年人脊椎治疗后，与其他提供商类型后的风险相比，脊骨疗法的脊柱操纵后，头部，颈部和躯干被选为头部，颈部和躯干的风险。该分析还将评估被视为脊椎治疗脊柱操纵禁忌症的伤害与现有条件之间的关联。在这个为期五年的项目结束时，该项目将包括在TDI上进行严格的正式培训计划以及指导的研究，候选人的目标是获得独立研究调查员的地位，并将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Medicare覆盖的人群的增加，对资源和CAM护理的提供的全面了解变得越来越重要。此外，必须认识到老年人并发症的风险。拟议的研究使用在TDI开创的既定技术和方法来解决这些紧迫的问题。