Hospital-Based Chiropractic Integration Within a
Large Private Hospital System in Minnesota:
A 10-Year Example

The Chiro.Org Blog

SOURCE:   J Manipulative Physiol Ther. 2009 (Nov); 32 (9): 740–748

Richard A. Branson, DC

Director of Chiropractic Services,
Fairview Sports and Orthopedic Care,
Fairview Health System,
Burnsville, MN 55337, USA.

OBJECTIVE:   The purpose of this article is to describe a model of chiropractic integration developed over a 10-year period within a private hospital system in Minnesota.

METHODS:   Needs were assessed by surveying attitudes and behaviors related to chiropractic and complementary and alternative medicine (CAM) of physicians associated with the hospital. Analyzing referral and utilization patterns assessed chiropractic integration into the hospital system.

RESULTS:   One hundred five surveys were returned after 2 mailings for a response rate of 74%. Seventy-four percent of respondents supported integration of CAM into the hospital system, although 45% supported the primary care physician as the gatekeeper for CAM use. From 2006 to 2008, there were 8,294 unique new patients in the chiropractic program. Primary care providers (medical doctors and physician assistants) were the most common referral source, followed by self-referred patients, sports medicine physicians, and orthopedic physicians. Overall examination of the program identified that facilitators of chiropractic integration were (1) growth in interest in CAM, (2) establishing relationships with key administrators and providers, (3) use of evidence-based practice, (4) adequate physical space, and (5) creation of an integrated spine care program. Barriers were (1) lack of understanding of chiropractic professional identity by certain providers and (2) certain financial aspects of third-party payment for chiropractic.

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CONCLUSION:   This article describes the process of integrating chiropractic into one of the largest private hospital systems in Minnesota from a business and professional perspective and the results achieved once chiropractic was integrated into the system. This study identified key factors that facilitated integration of services and demonstrates that chiropractic care can be successfully integrated within a hospital system.

From the Full-Text Article:


The purpose of health care is to improve the health of the public we serve. [1] Many types of providers, treatments, and tests exist in our health care system to meet this simple yet profound purpose. The complexity of the human body with all of its potential states of pain, dysfunction, and disease can overwhelm any individual health care provider. Good health care does not function as an individual or professional silo. Collaboration between health care providers and disciplines is essential in providing safe, quality, health care. [2] Within the medical profession alone, there is a dizzying array of subspecialties to treat all that ails us. Add to this list the choice of allied health professions such as dentistry, nursing, physical therapy, psychology, dietetics, and a vast array of medical technicians; and the choices for diagnosis and treatment become even more confusing. The health care industry is a complex web of medical, allied, and complementary and alternative medicine (CAM) providers. Some have referred to this confusing array of choices as being akin to shopping in the supermarket of health care. [3] The public and traditional medical providers that treat them must also contend with the various regulated and unregulated CAM professions. Near the top of this CAM list is the profession of chiropractic. Started over a century ago, this profession has metamorphosed into a regulated profession that lives somewhere between the traditional and alternative world of health care. [4] The vast majority of those in the chiropractic profession still practice in single-provider clinics. [5]

Collaboration between the traditional medical and chiropractic professions is a relatively new phenomenon. Historically, the 2 professions have worked in isolation of one another and often to extremes. In fact, as recent as 1983, the American Medical Association held that it was unethical for medical doctors to associate with the chiropractic profession, as it was labeled an unscientific cult. [6]

In 1993, Eisenberg et al [7] published a pivotal article in the New England Journal of Medicine on the use of unconventional medicine in the United States. This article reported a higher use of unconventional treatment, such as chiropractic, than previously published and sparked an interest in hospital-based care systems around the country to begin exploration of such treatments within traditional care systems. [8] Since that time, private hospitals around the country have begun to open their doors to the inclusion of CAM treatments. This has lead to a small but growing number of chiropractors being used by private hospital systems. The integration of chiropractic into mainstream health care is a model reviewed and ultimately recommended in 2005 by the Institute for Alternative Futures. [9]

The purpose of this article is to describe

(1)   the process of integrating chiropractic into one of the largest private hospital systems in Minnesota from a business and professional perspective

(2)   the facilitators and barriers to integration, and

(3)   the results achieved once chiropractic was integrated into the system.

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