PubMed · 7463691
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
R S Hosek, S B Schram, H Silverman, J B Myers, S E Williams. 1981-03-06. Cervical manipulation.. https://pubmed.ncbi.nlm.nih.gov/7463691/
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
OBJECTIVE: To compare health insurance payments and patient outcomes for recurrent episodes of care for nine common lumbar and low-back conditions initiated with chiropractic treatment vs. episodes initiated with medical treatment. DATA AND METHODS: Retrospective analysis of episodes constructed using 208 ICD-9-CM codes from 2 yr of insurance claims data for a large population of beneficiaries in the private fee-for-service sector. A total of 7077 patients were represented within 9314 episodes of care, of which 8018 episodes were initiated by clearly identified chiropractic or medical physicians. There were 1215 patients with initial physician or chiropractic-initiated episodes who had recurrent episodes. Outcome measures included total insurance payments, total outpatient payments, lengths of initial and recurrent episodes, consistent use of initiating providers for recurrent episodes and time lapsed between episodes. RESULTS: Total insurance payments within and across episodes were substantially greater for medically initiated episodes. Analysis of recurrent episodes as measures of patient outcomes indicated that chiropractic providers retain more patients for subsequent episodes, but that there is no significant difference in lapse time between episodes for chiropractic vs. medical providers. Chiropractic and medical patients were comparable on measures of severity; however, the chiropractic cohort included a greater proportion of chronic cases. CONCLUSION: Patients who "cross over" between providers for multiple episodes are more likely to return to chiropractic providers, which suggests that chronic, recurrent low-back cases may gravitate to chiropractic care over time. The findings from this and related studies point out the importance of appropriately operationalizing cost and outcome variables in analyses of care for conditions such as chronic and/or recurrent low-back pain.
OBJECTIVE: To develop and test a self-report survey instrument that measures the work performed by chiropractors in the delivery of evaluation and management (E/M) services and spinal manipulative therapy (SMT). Work is one leg of a triad used to develop Resource-Based Relative Values Scales (RBRVS) for physician reimbursement. DESIGN: Reliability study modeled after a tool designed and tested by economists at Harvard University School of Public Health in the development of relative values scales for physician reimbursement. The survey instrument uses magnitude estimation as a means of obtaining reliable and valid measures of the subjective assessments of the dimensions of a physicians work. SAMPLE: A random national sample was drawn from all members of the American Chiropractic Association. RESULTS: Estimates of the work performed by chiropractors in providing E/M and SMT services were established. The reliability of work ratings indicated that chiropractors agree closely on their ratings for work. The validity of the results indicated a high degree of consistency in rating work, which implies that the results are realistic. A review of demographics suggested that the survey population was representative of the general population of chiropractors. CONCLUSIONS: This study generated valid and reliable estimates of the work performed by chiropractors in providing E/M and SMT services. Work is one of three components used in the development of RBRVS, the method of physician reimbursement that is currently the industry standard. By quantifying the work required in providing services, chiropractors can now develop RBRVS. Additionally, the evidence-based data on work collected here can be used for a comparison with the work of similar services provided by other specialists. This can facilitate the use or modification of service description codes for use by chiropractic physicians.
OBJECTIVE: To compare U.S. chiropractic college admissions requirements with those of allopathy, osteopathy, optometry, podiatry and dentistry. DESIGN: Survey. PARTICIPANTS: The schools that participated in the comparison were selected based on their geographic location within the United States. The number of schools selected were 16 chiropractic college, 17 allopathic colleges, 16 osteopathic colleges, 16 optometric colleges, 7 podiatric colleges and 15 dental colleges. MAIN OUTCOME MEASURES: Information collected from the individual schools included: (a) minimum number of undergraduate semester hours (toward a bachelor's degree) that are required on entrance; (b) actual percentage of applicants with a 4-yr bachelor's degree on entrance; (c) minimum GPA required on entrance and (d) actual average GPA of applicants on entrance. RESULTS: Averages were computed for each outcome. Overall, allopathic averages were highest and chiropractic averages were lowest for each of the four outcome measures, with the other programs scoring at varying points in between. CONCLUSION: Successful completion of preprofessional requirements may be an indicator for success within a rigorous professional curriculum. These data reflect overall differences between health-care professions on a very few entrance criteria. Further investigation is needed to understand the long-term impact of these differences as well as the possible economic or political factors that may be influencing these results.