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

脊椎按摩治疗的可用性和背痛健康服务的使用

• 批准号: 9187422
• 负责人: Matthew A Davis
• 金额: $ 35.11万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-12-01 至 2019-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9187422
• 关键词: Address; Adult; Affect; American; Area; Automobile Driving; Back Pain; Caring; Chiropractor; Chronic; Chronic Disease; Clinical Management; Complementary and alternative medicine; Data; Dependency; Diabetes Mellitus; Diagnostic Imaging; Direct Costs; Elderly; Emergency department visit; Etiology; Expenditure; Geographic Information Systems; Goals; Health; Health Care Costs; Health Services; Healthcare; Healthcare Systems; Knowledge; Link; Location; Lung diseases; Measures; Medical; Medicare; Methods; Mission; Myocardial Ischemia; National Health Insurance; Natural experiment; Neck Pain; Opioid Analgesics; Pain management; Pathologic; Pathology; Pathway interactions; Patients; Physicians; Population; Practice Guidelines; Primary Care Physician; Primary Health Care; Provider; Public Health; Research; Research Design; Research Project Grants; Services; Symptoms; System; Testing; Time; United States National Institutes of Health; Vertebral column; Visit; Work; chiropracty; cost; disability; health care service utilization; health service use; innovation; medical specialties; novel; public health relevance; tool; Address; Adult; Affect; American; Area; Automobile Driving; Back Pain; Caring; Chiropractor; Chronic; Chronic Disease; Clinical Management; Complementary and alternative medicine; Data; Dependency; Diabetes Mellitus; Diagnostic Imaging; Direct Costs; Elderly; Emergency department visit; Etiology; Expenditure; Geographic Information Systems; Goals; Health; Health Care Costs; Health Services; Healthcare; Healthcare Systems; Knowledge; Link; Location; Lung diseases; Measures; Medical; Medicare; Methods; Mission; Myocardial Ischemia; National Health Insurance; Natural experiment; Neck Pain; Opioid Analgesics; Pain management; Pathologic; Pathology; Pathway interactions; Patients; Physicians; Population; Practice Guidelines; Primary Care Physician; Primary Health Care; Provider; Public Health; Research; Research Design; Research Project Grants; Services; Symptoms; System; Testing; Time; United States National Institutes of Health; Vertebral column; Visit; Work; chiropracty; cost; disability; health care service utilization; health service use; innovation; medical specialties; novel; public health relevance; tool

 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.

 描述（由适用提供）：背痛是美国人中残疾的主要因素，与美国经济的考虑成本有关。尽管既定的实践指南建议保守方法，但非特异性背痛的临床管理（即，不是由病理病因引起的背痛）各不相同，并且有过度使用阿片类镇痛药，早期诊断成像和专业护理的证据。特别是老年人对非特异性背痛的护理比年轻的疼痛差。尽管非特异性背痛是成年人拜访医师的主要原因之一，但它也恰好是依靠保守管理的补充和替代医学（CAM）提供者所治疗的最常见疾病之一。在美国，脊椎治疗界是最大，最有条理的凸轮组，脊椎治疗是Medicare涵盖的唯一CAM服务。但是，卫生决策者提供的当前信息缺乏对脊骨护理在Medicare中潜在的间接影响的基本了解。该项目的总体目的是严格检查脊骨疗法护理与利用率，支出和对非特异性背痛的护理之间的关系。我们的中心假设是，脊椎治疗被用作门诊医疗服务的替代品，并影响支出和非特异性背痛护理。该研究项目具有以下两个目的：（1）在老年人中，确定脊骨疗法护理的可用性影响在多大程度上影响和支出对非特异性背痛的卧床医疗服务（例如初级护理，特殊护理和急诊室就诊）的使用程度，并在老年人中确定脊架护理型临床管理的范围，以及（2）的范围内的静脉治疗范围。我们的方法具有创新性，因为它通过使用搬迁的Medicare患者进行现实世界中的自然实验来偏离当前现状。由于每个患者都可以作为自己的控制，因此这种严格的研究设计更适合识别毒性关系，并将使我们有独特的机会观察脊椎治疗可用性的变化的影响。为了衡量脊椎治疗和其他健康服务的可用性，我们将应用新颖的地理信息系统（GIS）工具。该提议的项目很重要，因为它将为健康决策者提供及时的信息，以预测医疗系统的重新设计影响；具体而言，在国家健康保险系统中纳入CAM服务如何影响非特异性背痛的老年人的护理。