Hurwitz Eric L, Vassilaki Maria, Li Dongmei, Schneider Michael J, Stevans Joel M, Phillips Reed B, Phelan Shawn P, Lewis Eugene A, Armstrong Richard C
Professor, Office of Public Health Studies, University of Hawaii at Mānoa, Honolulu, HI.
Research Associate, Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
J Manipulative Physiol Ther. 2016 May;39(4):229-39. doi: 10.1016/j.jmpt.2016.02.008.
The purpose of the study was to compare patterns of utilization and charges generated by medical doctors (MDs), doctors of chiropractic (DCs), and physical therapists (PTs) for the treatment of headache in North Carolina.
Retrospective analysis of claims data from the North Carolina State Health Plan for Teachers and State Employees from 2000 to 2009. Data were extracted from Blue Cross Blue Shield of North Carolina for the North Carolina State Health Plan using International Classification of Diseases, Ninth Revision, diagnostic codes for headache. The claims were separated by individual provider type, combination of provider types, and referral patterns.
The majority of patients and claims were in the MD-only or MD plus referral patterns. Chiropractic patterns represented less than 10% of patients. Care patterns with single-provider types and no referrals incurred the least charges on average for headache. When care did not include referral providers or services, MD with DC care was generally less expensive than MD care with PT. However, when combined with referral care, MD care with PT was generally less expensive. Compared with MD-only care, risk-adjusted charges (available 2006-2009) for patients in the middle risk quintile were significantly less for DC-only care.
Utilization and expenditures for headache treatment increased from 2000 to 2009 across all provider groups. MD care represented the majority of total allowed charges in this study. MD care and DC care, alone or in combination, were overall the least expensive patterns of headache care. Risk-adjusted charges were significantly less for DC-only care.
本研究旨在比较北卡罗来纳州内科医生（MD）、脊椎按摩治疗师（DC）和物理治疗师（PT）治疗头痛的使用模式和费用情况。
对2000年至2009年北卡罗来纳州教师和州政府雇员健康计划的理赔数据进行回顾性分析。使用国际疾病分类第九版头痛诊断代码，从北卡罗来纳州蓝十字蓝盾公司提取北卡罗来纳州健康计划的数据。理赔按个体提供者类型、提供者类型组合和转诊模式进行分类。
大多数患者和理赔属于仅内科医生模式或内科医生加转诊模式。脊椎按摩治疗模式的患者占比不到10%。单一提供者类型且无转诊的护理模式治疗头痛的平均费用最低。当护理不包括转诊提供者或服务时，内科医生与脊椎按摩治疗师联合护理通常比内科医生与物理治疗师联合护理费用更低。然而，当与转诊护理相结合时，内科医生与物理治疗师联合护理通常费用更低。与仅内科医生护理相比，中风险五分位数患者的风险调整费用（2006 - 2009年数据可用）在仅脊椎按摩治疗师护理时显著更低。
2000年至2009年期间，所有提供者群体的头痛治疗使用情况和支出均有所增加。在本研究中，内科医生护理占总允许费用的大部分。内科医生护理和脊椎按摩治疗师护理，单独或联合使用，总体上是头痛护理中费用最低的模式。仅脊椎按摩治疗师护理的风险调整费用显著更低。
