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Monthly Archives: June 2016

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Mixed-Methods Research in a Complex Multisite Veterans Affairs’ Health Services Study

By |June 18, 2016|Veterans|

Mixed-Methods Research in a Complex Multisite Veterans Affairs’ Health Services Study

The Chiro.Org Blog


SOURCE:   Evid Based Complement Alternat Med. 2013: 701280

Raheleh Khorsan, Angela B. Cohen, Anthony J. Lisi,
Monica M. Smith, Deborah Delevan, Courtney Armstrong,
and Brian S. Mittman

VA Center for Implementation Practice and Research Support,
VA Greater Los Angeles Healthcare System,
16111 Plummer Street,
Sepulveda, Los Angeles, CA 91343, USA


Maximizing the quality and benefits of newly established chiropractic services represents an important policy and practice goal for the US Department of Veterans Affairs’ healthcare system. Understanding the implementation process and characteristics of new chiropractic clinics and the determinants and consequences of these processes and characteristics is a critical first step in guiding quality improvement. This paper reports insights and lessons learned regarding the successful application of mixed methods research approaches-insights derived from a study of chiropractic clinic implementation and characteristics, Variations in the Implementation and Characteristics of Chiropractic Services in VA (VICCS). Challenges and solutions are presented in areas ranging from selection and recruitment of sites and participants to the collection and analysis of varied data sources. The VICCS study illustrates the importance of several factors in successful mixed-methods approaches, including (1) the importance of a formal, fully developed logic model to identify and link data sources, variables, and outcomes of interest to the study’s analysis plan and its data collection instruments and codebook and (2) ensuring that data collection methods, including mixed-methods, match study aims. Overall, successful application of a mixed-methods approach requires careful planning, frequent trade-offs, and complex coding and analysis.


The Full-Text Article:

Introduction

There is growing consumer interest in complementary and alternative medicine (CAM) in the USA and internationally. [1-3] Healthcare systems have responded to this demand by offering a range of CAM services in outpatient and inpatient settings. [4, 5] Patients enrolled in the US Department of Veterans Affairs (VA) healthcare delivery system often use CAM services outside of VA but have a strong interest in receiving these services within the VA system. [6-11] In response, VA began providing selected in-house CAM services in about 2001. [12] VA’s most substantial undertaking in delivering any CAM-related service has been its introduction of chiropractic services.

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Trends in the Use and Characteristics of Chiropractic Services in the Department of Veterans Affairs

By |June 15, 2016|Veterans|

Trends in the Use and Characteristics of Chiropractic Services in the Department of Veterans Affairs

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2016 (Jun); 39 (5): 381-6

Anthony J. Lisi, DC, Cynthia A. Brandt, MD, MPH

Chiropractic Section Chief,
VA Connecticut Healthcare System,
West Haven, CT;
Assistant Clinical Professor,
Yale Center for Medical Informatics,
Yale University School of Medicine,
New Haven, CT.


OBJECTIVES:   The purpose of this study was to analyze national trends and key features of the Department of Veterans Affairs’ (VA’s) chiropractic service delivery and chiropractic provider workforce since their initial inception

METHODS:   This was a serial cross-sectional analysis of the VA administrative data sampled from the first record of chiropractic services in VA through September 30, 2015. Data were obtained from VA’s Corporate Data Warehouse and analyzed with descriptive statistics.

RESULTS:   From October 1, 2004, through September 30, 2015, the annual number of patients seen in VA chiropractic clinics increased from 4052 to 37349 (821.7%), and the annual number of chiropractic visits increased from 20072 to 159366 (693.9%). The typical VA chiropractic patient is male, is between the ages of 45 and 64, is seen for low back and/or neck conditions, and receives chiropractic spinal manipulation and evaluation and management services. The total number of VA chiropractic clinics grew from 27 to 65 (9.4% annually), and the number of chiropractor employees grew from 13 to 86 (21.3% annually). The typical VA chiropractor employee is a 45.9-year-old man, has worked in VA for 4.5 years, and receives annual compensation of $97860. VA also purchased care from private sector chiropractors starting in 2000, growing to 159533 chiropractic visits for 19435 patients at a cost of $11155654 annually.

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National Medicare Equality Petition

By |June 11, 2016|Announcement|

National Medicare Equality Petition

The Chiro.Org Blog


SOURCE:   American Chiropractic Association (ACA)


The Time for Change is NOW

The American Chiropractic Association (ACA) has launched a major grassroots campaign to enact federal legislation that would allow doctors of chiropractic (DC) to perform to the fullest scope of their license in Medicare. This initiative would significantly improve the health and wellness of our nation’s aging population — and your support is urgently needed.

The National Medicare Equality Petition will raise awareness of how the current Medicare system shortchanges seniors who want and need the essential services provided by doctors of chiropractic (DCs) to stay healthy, pain free and mobile, and how DCs can be a part of the solution for what ails the U.S. health care system.


Petition to White House and Members of Congress

Give Seniors the Medicare Coverage They Need and Deserve: Full Access to and Reimbursement for Services Provided by Doctors of Chiropractic


Studies have shown that essential services provided by doctors of chiropractic (DCs) can help aging Americans live healthier and happier lives, yet every day our nation’s seniors are being unjustly denied full access to Medicare covered services by doctors of chiropractic that could improve their quality of life.

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Does Cervical Spine Manipulation Reduce Pain in People With Degenerative Cervical Radiculopathy?

By |June 8, 2016|Radiculopathy|

Does Cervical Spine Manipulation Reduce Pain in People With Degenerative Cervical Radiculopathy? A Systematic Review of the Evidence, and a Meta-analysis

The Chiro.Org Blog


SOURCE:   Clinical Rehabilitation 2016 (Feb); 30 (2): 145-155

Liguo Zhu, Xu Wei, Shangquan Wang

Department of Spine,
Wangjing Hospital, Beijing,
People’s Republic of China


OBJECTIVE:   To access the effectiveness and safety of cervical spine manipulation for cervical radiculopathy.

DATA SOURCES:   PubMed, the Cochrane Central Registry of Controlled Trials (CENTRAL) in the Cochrane Library, EMBASE, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Wanfang data, the website of Chinese clinical trial registry and international clinical trial registry by US National Institutes of Health.

REVIEW METHODS:   Randomized controlled trials that investigated the effects of cervical manipulation compared with no treatment, placebo or conventional therapies on pain measurement in patients with degenerative cervical radiculopathy were searched. Two authors independently evaluated the quality of the trials according to the risk of bias assessment provided by the PEDro (physiotherapy evidence database) scale. RevMan V.5.2.0 software was employed for data analysis. The GRADE approach was used to evaluate the overall quality of the evidence.

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Aging Baby Boomers and the Rising Cost of Chronic Back Pain

By |June 1, 2016|Low Back Pain|

Aging Baby Boomers and the Rising Cost of Chronic Back Pain: Secular Trend Analysis of Longitudinal Medical Expenditures Panel Survey Data for Years 2000 to 2007

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2013 (Jan); 36 (1): 2–11

Monica Smith, DC, PhD, Matthew A. Davis, DC, MPH,
Miron Stano, PhD, James M. Whedon, DC, MS

Adjunct Faculty (Off-Site),
National University Health Sciences,
Lombard, IL, USA.


OBJECTIVES:   The purposes of this study were to analyze data from the longitudinal Medical Expenditures Panel Survey (MEPS) to evaluate the impact of an aging population on secular trends in back pain and chronicity and to provide estimates of treatment costs for patients who used only ambulatory services.

METHODS:   Using the MEPS 2-year longitudinal data for years 2000 to 2007, we analyzed data from all adult respondents. Of the total number of MEPS respondent records analyzed (N = 71,838), we identified 12,104 respondents with back pain and further categorized 3842 as chronic cases and 8262 as nonchronic cases.

RESULTS:   Secular trends from the MEPS data indicate that the prevalence of back pain has increased by 29%, whereas chronic back pain increased by 64%. The average age among all adults with back pain increased from 45.9 to 48.2 years; the average age among adults with chronic back pain increased from 48.5 to 52.2 years. Inflation-adjusted (to 2010 dollars) biennial expenditures on ambulatory services for chronic back pain increased by 129% over the same period, from $15.6 billion in 2000 to 2001 to $35.7 billion in 2006 to 2007.

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Low Back Pain and Chiropractic Page

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