Hurwitz Eric L, Li Dongmei, Guillen Jenni, Schneider Michael J, Stevans Joel M, Phillips Reed B, Phelan Shawn P, Lewis Eugene A, Armstrong Richard C, Vassilaki Maria
Professor, Office of Public Health Studies, University of Hawaii at Mānoa, Honolulu, HI.
Associate Professor, Clinical and Translational Science Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY.
J Manipulative Physiol Ther. 2016 May;39(4):240-51. doi: 10.1016/j.jmpt.2016.02.007.
The purpose of the study was to compare utilization and charges generated by medical doctors (MD), doctors of chiropractic (DC) and physical therapists (PT) by provider patterns of care for the treatment of neck pain in North Carolina.
This was an analysis of neck-pain-related closed claim data from the North Carolina State Health Plan for Teachers and State Employees (NCSHP) from 2000 to 2009. Data were extracted from Blue Cross Blue Shield of North Carolina for the NCSHP using ICD-9 diagnostic codes for uncomplicated neck pain (UNP) and complicated neck pain (CNP).
Care patterns with single-provider types and no referrals incurred the least average charges for both UNP and CNP. When care did not include referral providers or services, for either UNP or CNP, MD care with PT was generally less expensive than MD care with DC care. However, when care involved referral providers or services, MD and PT care was on average more expensive than MD and DC care for either UNP or CNP. Risk-adjusted charges for patients in the middle quintile of risk (available 2006-2009) were lower for chiropractic patients with or without medical care or referral care to other providers.
Chiropractic care alone or DC with MD care incurred appreciably fewer charges for UNP or CNP compared to MD care with or without PT care, when care included referral providers or services. This finding was reversed when care did not include referral providers or services. Risk-adjusted charges for UNP and CNP patients were lower for DC care patterns.
本研究旨在通过北卡罗来纳州治疗颈部疼痛的医疗服务提供模式，比较医学博士（MD）、脊椎按摩治疗师（DC）和物理治疗师（PT）的医疗服务利用率及费用。
这是一项对2000年至2009年北卡罗来纳州教师和州政府雇员健康计划（NCSHP）中与颈部疼痛相关的结案索赔数据的分析。使用国际疾病分类第九版（ICD - 9）诊断代码，从不复杂颈部疼痛（UNP）和复杂颈部疼痛（CNP）中，从北卡罗来纳州蓝十字蓝盾公司提取NCSHP的数据。
单一提供者类型且无转诊的护理模式，对于UNP和CNP的平均费用最低。当护理不包括转诊提供者或服务时，对于UNP或CNP，MD与PT联合的护理通常比MD与DC联合的护理费用更低。然而，当护理涉及转诊提供者或服务时，对于UNP或CNP，MD与PT联合的护理平均比MD与DC联合的护理费用更高。2006 - 2009年期间，处于风险中五分位数的患者，无论有无医疗护理或转诊至其他提供者的脊椎按摩治疗患者的风险调整费用更低。
当护理包括转诊提供者或服务时，与有或没有PT护理的MD护理相比，单独的脊椎按摩治疗护理或DC与MD联合护理产生的UNP或CNP费用明显更少。当护理不包括转诊提供者或服务时，这一发现则相反。DC护理模式下UNP和CNP患者的风险调整费用更低。
