Effect of chiropractic on costs of Medicare patients with multiple comorbidities

脊椎按摩疗法对患有多种合并症的医疗保险患者费用的影响

基本信息

批准号：
8724343
负责人：
WILLIAM B WEEKS
金额：
$ 11.59万
依托单位：
DARTMOUTH COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-01 至 2015-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8724343
关键词：
Accounting Acute Adult Age Ambulatory Care Applications Grants Back Pain Caring Chiropractor Chronic low back pain Clinical Trials Clinical Trials Design Comorbidity Consumption Cost Savings Cross-Sectional Studies Data Diagnosis Doctor of Chiropractic Dose Economic Inflation Effectiveness Elderly Evaluation Expenditure Future Growth Health Health Care Costs Healthcare Healthcare Systems Incidence Inpatients Knowledge Low Back Pain Mediating Medical Medicare Medicare Part A Medicare Part B Medicare claim Methodology Modeling Musculoskeletal Musculoskeletal Pain Outcome Outpatients Patients Pattern Patterns of Care Pharmacologic Substance Population Price Race Randomized Research Resources Sample Size Specific qualifier value Technology Time United States Work aged aging population base beneficiary chiropracty cohort cost design experience geographic difference health care delivery health care service utilization human old age (65+)improved insight neuromuscular older patient patient population pragmatic trial primary outcome prospective psychologic response sex skeletal trend

项目摘要

DESCRIPTION (provided by applicant): United States healthcare costs are rising inexorably. Patients who have multiple co-morbidities account for a substantial portion of healthcare costs, and efforts to 'bend the cost curve' tend to focus on this patient population. Low back pain is an increasingly common diagnosis among older adults, and the costs for treating it are accelerating, fueled in part by the multiple co-morbidities that these patients have. Other research finds that older Medicare patients with neuromuscular-skeletal diagnoses who obtain chiropractic care have substantially lower Medicare Part B costs than those who do not. In addition, between 2003 - 2008 annual Medicare cost growth was lower for patients who used chiropractic care than those who did not. However, these findings were limited to evaluation of Medicare Part B costs and examined a very broad group of patients. This application will explore potential cost savings to Medicare associated with use of chiropractic care in patients with multiple comorbidities. Specifically, the proposed study will use data from 2006-2011 to conduct serial cross-sectional analyses that will examine the association between use of chiropractic care and healthcare costs among older Medicare patients with a diagnosis of low back pain, a musculoskeletal condition associated with low back pain, and a psychological comorbidity that might be improved should musculoskeletal pain be relieved. The conceptual model that drives the application suggests that these comorbidities might directly or indirectly benefit from chiropractic care. A serial cross sectional analysis will allow for the identificatio of patients with low back pain and multiple comorbidities. The research will compare such patients who did and who did not use chiropractic care during the year. Primary outcomes will be the average annual Total Medicare costs as well as average annual costs for each of the three Medicare components examined (Part A, Part B, and Part D). The study will inform policymakers as they consider the effective and efficient use of chiropractic care in older, sicker patients. Should evidence exist of a cost offset associated with chiropractic care, it will be used to develop an R01 grant proposal to conduct a randomized pragmatic trial designed to prospectively evaluate the effect of chiropractic care on health services utilization, costs of car, and patient outcomes among older, multiply comorbid patients.

描述（由申请人提供）：美国的医疗保健费用正在上升。具有多种合并症的患者占医疗费用的很大一部分，而“弯曲成本曲线”的努力倾向于集中在该患者人群上。腰痛是老年人越来越普遍的诊断，治疗的成本正在加速，部分原因是这些患者的多种合并症。其他研究发现，接受脊骨疗法护理的神经肌肉骨骼诊断的老年医疗保险患者比没有的医疗保险的成本大大低。此外，在2003年至2008年之间，使用脊椎治疗的患者的年度医疗保险成本增长要比没有患者低。但是，这些发现仅限于评估Medicare B部分成本，并检查了一群非常广泛的患者。该应用程序将探索与多种合并症患者使用脊椎治疗相关的医疗保险的潜在节省成本。具体而言，拟议的研究将使用2006年至2011年的数据进行连续的横断面分析，这些分析将研究脊骨疗法护理和医疗保健成本之间的使用之间的关联，并在诊断为下背部疼痛的老年医疗保健患者中，与下背部疼痛相关的肌肉骨骼状况，以及可能会改善肌肉疼痛的肌肉性相关的肌肉骨骼状况。推动应用程序的概念模型表明，这些合并症可能直接或间接地从脊椎治疗中受益。串行横截面分析将允许识别腰痛和多种合并症的患者。这项研究将比较此类患者在这一年中没有使用脊椎治疗的患者。主要结果将是所检查的三个Medicare组件中的每个Medicare组件中的每一个平均年度医疗保险总成本以及平均年成本（A部分，B部分和D部分）。这项研究将为决策者提供信息，因为他们认为在更老，病态的脊椎治疗有效地使用脊椎治疗患者。如果存在与脊椎治疗相关的成本偏移的证据，则将使用为了开发R01赠款建议，以进行随机务实的试验，旨在评估脊椎治疗对卫生服务利用率，汽车成本和患者结果的影响。