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Chiropractic Integration into Private Sector Medical Facilities:
A Multisite Qualitative Case Study

By |July 23, 2018|Integrative Care|

Chiropractic Integration into Private Sector Medical Facilities:
A Multisite Qualitative Case Study

The Chiro.Org Blog


SOURCE:   J Altern Complement Med. 2018 (Jul 17) [Epub]

Anthony J. Lisi, DC, Stacie A. Salsbury, PhD, RN, Elissa J. Twist, DC, MS, and Christine M. Goertz, DC, PhD

Pain Research,
Informatics, Multi-Comorbidities and Education Center,
VA Connecticut Healthcare System,
West Haven, CT.


OBJECTIVES:   Chiropractic care may have value in improving patient outcomes and decreasing opioid use, but little is known about the impetus for or process of incorporating these services into conventional medical settings. The purpose of this qualitative study was to describe organizational structures, care processes, and perceived value of chiropractic integration within U.S. private sector medical facilities.

DESIGN:   Multisite, comparative organizational case study.

SETTINGS:   Nine U.S. private sector medical facilities with on-site chiropractic care, including five hospitals and four clinics.

PARTICIPANTS:   One hundred and thirty-five key facility stakeholders including doctors of chiropractic (DCs), non-DC clinicians, support staff, administrators, and patients.

METHODS:   Researchers conducted 2-day site visits to all settings. Qualitative data were collected from audio-recorded, semi-structured, role-specified, individual interviews; standardized organizational data tables; and archival document review. A three-member, interdisciplinary team conducted thematic content analysis of verbatim transcripts using an existing conceptual framework and emergent codes.

RESULTS:   These nine medical facilities had unique organizational structures and reasons for initiating chiropractic care in their settings. Across sites, DCs were sought to take an evidence-based approach to patient care, work collaboratively within a multidisciplinary team, engage in interprofessional case management, and adopt organizational mission and values. Chiropractic clinics were implemented within existing human resources, physical plant, information technology, and administrative support systems, and often expanded over time to address patient demand. DCs usually were co-located with medical providers and integrated into the collaborative management of patients with musculoskeletal and co-morbid conditions. Delivery of chiropractic services was perceived to have high value among patients, medical providers, and administration. Patient clinical outcomes, patient satisfaction, provider productivity, and cost offset were identified as markers of clinic success.

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Principles in Integrative Chiropractic

By |July 17, 2018|Integrative Care|

Principles in Integrative Chiropractic

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SOURCE:   J Manipulative Physiol Ther. 2003 (May); 26 (4): 254–272

J.Michael Menke, DC

Program in Internal Medicine,
University of Arizona,
Tucson 85719, USA.


As the public acceptance of chiropractic continues to grow in the United States, [1-3] the private practice chiropractor may find opportunities for formal inclusion in the fast growing integration of complementary and alternative medicine (CAM) into health care delivery. The ability of chiropractors to respond confidently to integration into the overall health care system may be the next step in gaining access to more patients and improving the health care quality.

This necessity for chiropractors to become part of the evolving health care system and still maintain a strong chiropractic identity will be essential, since chiropractic’s value lies in cultivating and delivering the very elements that have made it so high in patient satisfaction: emphasis on biomechanics, manual therapy of the spine, good patient rapport, and strong patient-physician bond. [4, 5] However, there are several barriers to integration: consumer, medical, and chiropractic itself.

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Be Good, Communicate, and Collaborate: A Qualitative Analysis of Stakeholder Perspectives on Adding a Chiropractor to the Multidisciplinary Rehabilitation Team

By |June 24, 2018|Integrative Care|

Be Good, Communicate, and Collaborate: A Qualitative Analysis of Stakeholder Perspectives on Adding a Chiropractor to the Multidisciplinary Rehabilitation Team

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2018 (Jun 22); 26: 29

Stacie A. Salsbury, Robert D. Vining, Donna Gosselin and Christine M. Goertz

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
Davenport, USA


Background   While 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.

Methods   This 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.

Results   Sixty 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 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.

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Developing Integrative Primary Healthcare Delivery: Adding a Chiropractor to the Team

By |June 21, 2018|Integrative Care|

Developing Integrative Primary Healthcare Delivery: Adding a Chiropractor to the Team

The Chiro.Org Blog


SOURCE:   Explore (NY). 2008 (Jan); 4 (1): 18–24

Michael J. Garner, MSc, Michael Birmingham, PhD, Peter Aker, MSc, DC, David Moher, PhD,
Jeff Balon, DC, MD, Dirk Keenan, DC, and Pran Manga, PhD

Carlington Community and Health Services,
Ottawa, Ontario, Canada.


BACKGROUND:   The use of complementary and alternative medicine has been increasing in Canada despite the lack of coverage under the universal public health insurance system. Physicians and other healthcare practitioners are now being placed in multidisciplinary teams, yet little research on integration exists.

OBJECTIVE:   We sought to investigate the effect of integrating chiropractic on the attitudes of providers on two healthcare teams.

DESIGN:   A mixed methods design with both quantitative and qualitative components was used to assess the healthcare teams. Assessment occurred prior to integration, at midstudy, and at the end of the study (18 months).

SETTING:   Multidisciplinary healthcare teams at two community health centers in Ottawa, Ontario, participated in the study.

PATIENTS/PARTICIPANTS:   All physicians, nurse practitioners, and degree-trained nurses employed at two study sites were approached to take part in the study.

INTERVENTION:   A chiropractor was introduced into each of the two healthcare teams.

MAIN OUTCOME MEASURES:   A quantitative questionnaire assessed providers’ opinions, experiences with collaboration, and perceptions of chiropractic care. Focus groups were used to encourage providers to communicate their experiences and perceptions of the integration and of chiropractic.

RESULTS:   Twelve providers were followed for the full 18 months of integration. The providers expressed increased willingness to trust the chiropractors in shared care (F value = 7.18; P = .004). Questions regarding the legitimacy (F value = 12.33; P < .001) and effectiveness (F value = 11.17; P < .001) of chiropractic became increasingly positive by study end.

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A Survey of American Chiropractic Association Members’ Experiences, Attitudes, and Perceptions of Practice in Integrated Health Care Settings

By |April 24, 2018|Integrative Care|

A Survey of American Chiropractic Association Members’ Experiences, Attitudes, and Perceptions of Practice in Integrated Health Care Settings

The Chiro.Org Blog


SOURCE:   J Chiropractic Medicine 2015 (Dec); 14 (4): 227–239

Leo J. Bronston, DC, Lauren E. Austin-McClellan, DC, MS, Anthony J. Lisi, DC, Kevin C. Donovan, DC, and Walter W. Engle, DC

University of Bridgeport College of Chiropractic,
Bridgeport, CT;
Staff Chiropractor,
VA Connecticut Healthcare System,
West Haven, CT.


OBJECTIVE:   The purpose of this study is to examine the self-report of experiences, attitudes, and perceived educational needs of American Chiropractic Association members regarding practice in integrated health care settings.

METHODS:   This was a descriptive observational study of the American Chiropractic Association members. Participants completed an electronic survey reporting their current participation and interest in chiropractic integrated practice.

RESULTS:   The survey was completed in 2011 by 1142 respondents, for a response rate of 11.8%. The majority of respondents (82.9%) did not currently practice in an integrated setting, whereas 17.1% did. Those practicing in various integrated medical settings reported delivering a range of diagnostic, therapeutic, and case management services. Participation in administrative and scholarly activities was less common. Respondents not practicing in integrated settings reported being interested in delivering a very similar array of clinical services. Doctors of chiropractic practicing in hospital or outpatient medical facilities reported frequent engagement in interprofessional collaboration. Both nonintegrated and integrated respondents reported very similar educational interests on a range of clinical topics.

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Integration of Doctors of Chiropractic Into Private Sector Health Care Facilities in the United States

By |April 13, 2018|Integrative Care|

Integration of Doctors of Chiropractic Into Private Sector Health Care Facilities in the United States: A Descriptive Survey

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2018 (Feb); 41 (2): 149–155

Stacie A. Salsbury, PhD, RN, Christine M. Goertz, DC, PhD, Elissa J. Twist, DC, MS, Anthony J. Lisi, DC

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
Davenport, Iowa.


OBJECTIVE:   The purpose of this study was to describe the demographic, facility, and practice characteristics of doctors of chiropractic (DCs) working in private sector health care settings in the United States.

METHODS:   We conducted an online, cross-sectional survey using a purposive sample of DCs (n = 50) working in integrated health care facilities. The 36-item survey collected demographic, facility, chiropractic, and interdisciplinary practice characteristics, which were analyzed with descriptive statistics.

RESULTS:   The response rate was 76% (n = 38). Most respondents were men and mid-career professionals with a mean 21 years of experience in chiropractic. Doctors of chiropractic reported working in hospitals (40%), multispecialty offices (21%), ambulatory clinics (16%), or other (21%) health care settings. Most (68%) were employees and received salary compensation (59%). The median number of DCs per setting was 2 (range 1–8). Most DCs used the same health record as medical staff and worked in the same clinical setting. More than 60% reported co-management of patients with medical professionals. Integrated DCs most often received and made referrals to primary care, physical medicine, pain medicine, orthopedics, and physical or occupational therapy. Although in many facilities the DCs were exclusive providers of spinal manipulation (43%), in most, manipulative therapies also were delivered by physical therapists and osteopathic or medical physicians. Informal face-to-face consultations and shared health records were the most common communication methods.

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