A proposal to improve health-care value in spine care delivery: the primary spine practitioner

Goertz, Christine; Weeks, William B.; Justice, Blake D.; Haldeman, Scott

doi:10.1016/j.spinee.2017.06.013

Cited by 16 publications

(12 citation statements)

References 52 publications

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“…These preferred qualities identified by rehabilitation stakeholders align with many proposed indicators of professional excellence outlined in a recent commentary on ‘the new chiropractic’ [ 37 ] and both old and new calls for chiropractors to assume a leading role in musculoskeletal health as spine care practitioners [ 38 – 40 ]. For example, the clinical acumen of chiropractic students might improve substantially through proposed hospital-based rotations that emphasize the evaluation and treatment of the musculoskeletal problems for persons with multiple comorbidities, such as neurological disorders [ 37 ].…”

Section: Discussionmentioning

confidence: 63%

“…Engagement in clinical experiences based in a wider array of healthcare settings than chiropractic clinics could increase chiropractors’ expertise working with patients who rely upon medical devices, adaptive technologies, and transfer equipment, as is common in rehabilitation settings, including the facility which served as this research site [ 28 , 29 ]. Such hospital-based training also could increase chiropractors’ knowledge and application of the biopsychosocial model [ 29 , 40 ], which might impact their proficiency within the intrapersonal domain as described by our participants. Multidisciplinary training would allow more opportunity to interact with healthcare providers from other disciplines, and for providers of those disciplines to work with chiropractic providers, potentially sowing seeds for interprofessional teamwork after graduation [ 24 , 41 – 43 ].…”

Section: Discussionmentioning

confidence: 99%

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Be good, communicate, and collaborate: a qualitative analysis of stakeholder perspectives on adding a chiropractor to the multidisciplinary rehabilitation team

et al. 2018

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BackgroundWhile chiropractors are integrating into multidisciplinary settings with increasing frequency, the perceptions of medical providers and patients toward adding chiropractors to existing healthcare teams is not well-understood. This study explored the qualities preferred in a chiropractor by key stakeholders in a neurorehabilitation setting.MethodsThis qualitative analysis was part of a multi-phase, organizational case study designed to evaluate the planned integration of a chiropractor into a multidisciplinary rehabilitation team. The setting was a 62-bed rehabilitation specialty hospital located in the northeastern United States. Participants included patients, families, community members, and professional staff of the administrative, medical, nursing, and therapy departments. Data collection consisted of audiotaped, individual interviews and profession-specific focus groups guided by a semi-structured interview schedule. Transcripts were imported into a qualitative data analysis program for data analysis. An iterative coding process using thematic content analysis categorized key themes and domains.ResultsSixty participants were interviewed in June 2015, including 48 staff members, 6 patients, 4 family members, and 2 community members. Our analysis generated a conceptual model of The Preferred Chiropractor for Multidisciplinary Rehabilitation Settings composed of 5 domains and 13 themes. The central domain, Patient-Centeredness, or the provision of healthcare that is respectful, responsive, and inclusive of the patient’s values, preferences, and needs, was mentioned in all interviews and linked to all other themes. The Professional Qualities domain highlighted clinical acumen, efficacious treatment, and being a safe practitioner. Interpersonal Qualities encouraged chiropractors to offer patients their comforting patience, familiar connections, and emotional intelligence. Interprofessional Qualities emphasized teamwork, resourcefulness, and openness to feedback as characteristics to enhance the chiropractor’s ability to work within an interdisciplinary setting. Organizational Qualities, including personality fit, institutional compliance, and mission alignment were important attributes for working in a specific healthcare organization.ConclusionsOur findings provide an expanded view of the qualities that chiropractors might bring to multidisciplinary healthcare settings. Rather than labeling stakeholder perceptions as good, bad or indifferent as in previous studies, these results highlight specific attributes chiropractors might cultivate to enhance the patient outcomes and the experience of healthcare, influence clinical decision-making and interprofessional teamwork, and impact healthcare organizations.Electronic supplementary materialThe online version of this article (10.1186/s12998-018-0200-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Be good, communicate, and collaborate: a qualitative analysis of stakeholder perspectives on adding a chiropractor to the multidisciplinary rehabilitation team

et al. 2018

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“…In the GSCI model of care, primary spine care is delivered by healthcare providers with training and skills in evidencebased spine care [7]. This is consistent with the recommendations of others who have looked at the skills required to manage patients with nonspecific spine pain [32,33]. Necessary skills include the initial assessment of patients, triage for red flags suggestive of serious pathology, documentation of psychological or social flags and the management of patients with nonspecific pain and related disability (Class I and II) [11,18].…”

Section: Primary Spine Carementioning

confidence: 62%

The Global Spine Care Initiative: resources to implement a spine care program

et al. 2018

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To our knowledge, this is the first international and interprofessional attempt to develop a list of resources needed to deliver care in an evidence-based care pathway for the management of people presenting with spine-related concerns. This resource list needs to be field tested in a variety of communities with different resource capacities to verify its utility. These slides can be retrieved under Electronic Supplementary Material.

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“…However, our findings do appear to provide additional weight to the evidence in favor of adopting a comprehensive, conservative care pathway to reduce costs for the primary care of patients with spinal pain disorders even within chiropractic care settings. This general approach has been described as the Primary Spine Care model of care for patients with spine related disorders [ 15 ]. Primary Spine Practitioner is a first-contact provider for patients with spinal problems, for practitioners that desire to work in a team-based environment that comprehensively manages and coordinates the care for individuals with these spine-related disorders.…”

Section: Discussionmentioning

confidence: 99%

Cost comparison of two approaches to chiropractic care for patients with acute and sub-acute low Back pain care episodes: a cohort study

Whedon

Bezdjian

Dennis³

et al. 2020

Chiropr Man Therap

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Background Low back pain (LBP) imposes a costly burden upon patients, healthcare insurers, and society overall. Spinal manipulation as practiced by chiropractors has been found be cost-effective for treatment of LBP, but there is wide variation among chiropractors in their approach to clinical care, and the most cost-effective approach to chiropractic care is uncertain. To date, little has been published regarding the cost effectiveness of different approaches to chiropractic care. Thus, the current study presents a cost comparison between chiropractic approaches for patients with acute or subacute care episodes for low back pain. Methods We employed a retrospective cohort design to examine costs of chiropractic care among patients diagnosed with acute or subacute low back pain. The study time period ranged between 07/01/2016 and 12/22/2017. We compared cost outcomes for patients of two cohorts of chiropractors within health care system: Cohort 1) a general network of providers, and Cohort 2) a network providing conservative evidence-based care for rapid resolution of pain. We used generalized linear regression modeling to estimate the comparative influence of demographic and clinical factors on expenditures. Results A total of 25,621 unique patients were included in the analyses. The average cost per patient for Cohort 2 (mean allowed amount $252) was lower compared to Cohort 1 (mean allowed amount $326; 0.77, 95% CI 0.75–0.79, p < .001). Patient and clinician related factors such as health plan, provider region, and sex also significantly influenced costs. Conclusions This study comprehensively analyzed cost data associated with the chiropractic care of adults with acute or sub-acute low back pain cared by two cohorts of chiropractic physicians. In general, providers in Cohort 2 were found to be significantly associated with lower costs for patient care as compared to Cohort 1. Utilization of a clinical model characterized by a patient-centered clinic approach and standardized, best-practice clinical protocols may offer lower cost when compared to non-standardized clinical approaches to chiropractic care.

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A proposal to improve health-care value in spine care delivery: the primary spine practitioner

Cited by 16 publications

References 52 publications

Be good, communicate, and collaborate: a qualitative analysis of stakeholder perspectives on adding a chiropractor to the multidisciplinary rehabilitation team

Be good, communicate, and collaborate: a qualitative analysis of stakeholder perspectives on adding a chiropractor to the multidisciplinary rehabilitation team

The Global Spine Care Initiative: resources to implement a spine care program

Cost comparison of two approaches to chiropractic care for patients with acute and sub-acute low Back pain care episodes: a cohort study

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