Chiropractic Goes To The Hospital
SOURCE: J Manipulative Physiol Ther 2011 (Feb); 34 (2): 98–106
Paskowski I, Schneider M, Stevans J,
Ventura JM, Justice BD.
Medical Back Pain Program,
This hospital-based study is interesting for several reasons:
- First, they utilized an evidence-based program for treating low back pain (LBP)
- Based on that evidence, they assigned 83% of those who sought care to chiropractic management.
- Results for the patients treated by doctors of chiropractic were mean of 5.2 visits, mean cost per case of $302, and
- 95% of those patients rated their care as “excellent.”
OBJECTIVE: A health care facility (Jordan Hospital) implemented a multidimensional spine care pathway (SCP) using the National Center for Quality Assurance (NCQA) Back Pain Recognition Program (BPRP) as its foundation. The purpose of this report is to describe the implementation and results of a multidisciplinary, evidence-based, standardized process to improve clinical outcomes and reduce costs associated with treatment and diagnostic testing.
METHODS: A standardized SCP was developed to improve the quality of back pain care. The NCQA BPRP provided the framework for the SCP to determine the standard of quality care delivered. Patients were triaged, and suitable patients were categorized into 1 of 5 classifications based upon history and examination, directional exercise flexion or “extension biases,” spinal manipulation, traction, or spinal stabilization exercises.
RESULTS: The findings for 518 consecutive patients were included. One hundred sixteen patients (10%) were seen once and triaged to specialty care; 7% of patients received magnetic resonance imagings. Four hundred thirty-two patients (83%) were classified and treated by doctors of chiropractic and/or physical therapists. Results for the patients treated by doctors of chiropractic were mean of 5.2 visits, mean cost per case of $302, mean intake pain rating score of 6.2 of 10, and mean discharge score of 1.9 of 10; 95% of patients rated their care as “excellent.”
CONCLUSIONS: By adopting the NCQA BPRP as an SCP, training physicians in this SCP, and using a back pain classification, Jordan Hospital Spine Care demonstrated the quality and value of care rendered to a population of patients. This was accomplished with a relatively low cost and with high patient satisfaction.
From the FULL TEXT Article
Low back pain (LBP) is a substantial public health issue that puts pressure on the financial resources across the entire health care systems worldwide. The lifetime prevalence of LBP in most industrialized countries varies between 60% and 85%; therefore, most adults can expect to experience an episode of LBP at least once during their lifetime. Approximately 25% of American adults reported experiencing an episode of LBP during the previous 3 months. According to the National Center for Complementary and Alternative Medicine, LBP is the fifth most common reason why people seek care from their primary care physicians, the leading cause of disability and missed days of work in working age adults, and the most common condition for which US adults seek complementary and alternative treatment. A 2006 report estimated that the direct and indirect costs of LBP in the United States are more than $100 billion annually. Patients with back pain incur 73% higher health care costs than those without back pain–related complaints. Much of this cost is related to improper management of LBP, especially with respect to unnecessary diagnostic imaging, medications, and spinal injections.