Chiropractic Episodes and the Co-Occurrence of Chiropractic and Health Services Use Among Older Medicare Beneficiaries

Weigel, Paula; Hockenberry, Jason M.; Bentler, Suzanne E.; Kaskie, Brian; Wolinsky, Fredric D.

doi:10.1016/j.jmpt.2012.01.011

Cited by 24 publications

(33 citation statements)

References 25 publications

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“…Informed by Liliedahl 42 and Weigel, 43 we identified patients who used 1 of 4 treatments during their episode: 1) only CMT; 2) conventional medical care followed by CMT; 3) CMT followed by conventional medical care; and 4) only conventional medical care.…”

Section: Methodsmentioning

confidence: 99%

The Association Between Use of Chiropractic Care and Costs of Care Among Older Medicare Patients With Chronic Low Back Pain and Multiple Comorbidities

Weeks

Leininger

Whedon

et al. 2016

Journal of Manipulative and Physiological Therapeutics

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Objective The purpose of this study was to determine whether use of chiropractic manipulative treatment (CMT) was associated with lower healthcare costs among multiply-comorbid Medicare beneficiaries with an episode of chronic low back pain (cLBP). Methods We conducted an observational, retrospective study of 2006–2012 Medicare fee-for-service reimbursements for 72,326 multiply-comorbid patients aged 66 and older with cLBP episodes and 1 of 4 treatment exposures: chiropractic manipulative treatment (CMT) alone, CMT followed or preceded by conventional medical care, or conventional medical care alone. We used propensity score weighting to address selection bias. Results After propensity score weighting, total and per-episode day Part A, Part B, and Part D Medicare reimbursements during the cLBP treatment episode were lowest for patients who used CMT alone; these patients had higher rates of healthcare use for low back pain but lower rates of back surgery in the year following the treatment episode. Expenditures were greatest for patients receiving medical care alone; order was irrelevant when both CMT and medical treatment were provided. Patients who used only CMT had the lowest annual growth rates in almost all Medicare expenditure categories. While patients who used only CMT had the lowest Part A and Part B expenditures per episode day, we found no indication of lower psychiatric or pain medication expenditures associated with CMT. Conclusions This study found that older multiply-comorbid patients who used only CMT during their cLBP episodes had lower overall costs of care, shorter episodes, and lower cost of care per episode day than patients in the other treatment groups. Further, costs of care for the episode and per episode day were lower for patients who used a combination of CMT and conventional medical care than for patients who did not use any CMT. These findings support initial CMT use in the treatment of, and possibly broader chiropractic management of, older multiply-comorbid cLBP patients

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Section: Methodsmentioning

confidence: 99%

The Association Between Use of Chiropractic Care and Costs of Care Among Older Medicare Patients With Chronic Low Back Pain and Multiple Comorbidities

Weeks

Leininger

Whedon

et al. 2016

Journal of Manipulative and Physiological Therapeutics

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“…While a participant in the chiropractic treatment group could also use other non-chiropractic services for spine treatment, prior research has indicated that conditional upon choosing chiropractic for a particular care episode, the vast majority of services used during that episode are chiropractic. 27,33 …”

Section: Methodsmentioning

confidence: 99%

Chiropractic Use in the Medicare Population: Prevalence, Patterns, and Associations With 1-Year Changes in Health and Satisfaction With Care

Weigel

Hockenberry

Wolinsky

2014

Journal of Manipulative and Physiological Therapeutics

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Objective The purpose of this study was to examine how chiropractic care compares to medical treatments on one-year changes in self-reported function, health, and satisfaction with care measures in a representative sample of Medicare beneficiaries. Methods Logistic regression using generalized estimating equations (GEE) is used to model the effect of chiropractic relative to medical care on decline in five functional measures and two measures of self-rated health among 12,170 person-year observations. The same method is used to estimate the comparative effect of chiropractic on six satisfaction with care measures. Two analytic approaches are used, the first assuming no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models. Results The unadjusted models show chiropractic is significantly protective against one-year decline in ADLs, lifting, stooping, walking, self-rated health, and worsening health after one year. Persons using chiropractic are more satisfied with their follow-up care and with the information provided to them. In addition to the protective effects of chiropractic in the unadjusted model, the propensity score results indicate a significant protective effect of chiropractic against decline in reaching. Conclusion This study provides evidence of a protective effect of chiropractic care against one-year declines in functional and self-rated health among Medicare beneficiaries with spine conditions, and indications that chiropractic users have higher satisfaction with follow-up care and information provided about what is wrong with them.

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“…35–37 A provoking finding was that <10% of chiropractic users also use other medical services for the same episode of care. 38 There is some evidence that individuals become accustomed to seeking chiropractic care, possibly because of lower satisfaction with medical care. 37,39,40 Our findings may indicate that chiropractic care may be used as a substitute for (rather than in addition to) medical care.…”

Section: Discussionmentioning

confidence: 99%

Regional Supply of Chiropractic Care and Visits to Primary Care Physicians for Back and Neck Pain

Davis

Yakusheva

Gottlieb

et al. 2015

The Journal of the American Board of Family Medicine

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Background Whether availability of chiropractic care affects use of primary care physician (PCP) services is unknown. Methods We performed a cross-sectional study of 17.7 million older adults who were enrolled in Medicare from 2010 to 2011. We examined the relationship between regional supply of chiropractic care and PCP services using Spearman correlation. Generalized linear models were used to examine the association between regional supply of chiropractic care and number of annual visits to PCPs for back and/or neck pain. Results We found a positive association between regional supply of chiropractic care and PCP services (rs = 0.52; P <.001). An inverse association between supply of chiropractic care and the number of annual visits to PCPs for back and/or neck pain was apparent. The number of PCP visits for back and/or neck pain was 8% lower (rate ratio, 0.92; 95% confidence interval, 0.91–0.92) in the quintile with the highest supply of chiropractic care compared to the lowest quintile. We estimate chiropractic care is associated with a reduction of 0.37 million visits to PCPs nationally, at a cost of $83.5 million. Conclusions Greater availability of chiropractic care in some areas may be offsetting PCP services for back and/or neck pain among older adults. (J Am Board Fam Med 2015;28:000–000.)

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Chiropractic Episodes and the Co-Occurrence of Chiropractic and Health Services Use Among Older Medicare Beneficiaries

Cited by 24 publications

References 25 publications

The Association Between Use of Chiropractic Care and Costs of Care Among Older Medicare Patients With Chronic Low Back Pain and Multiple Comorbidities

The Association Between Use of Chiropractic Care and Costs of Care Among Older Medicare Patients With Chronic Low Back Pain and Multiple Comorbidities

Chiropractic Use in the Medicare Population: Prevalence, Patterns, and Associations With 1-Year Changes in Health and Satisfaction With Care

Regional Supply of Chiropractic Care and Visits to Primary Care Physicians for Back and Neck Pain

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