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 Hawai`i 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):252-62. doi: 10.1016/j.jmpt.2016.02.006.
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 patterns of care for the treatment of low back pain in North Carolina.
This was an analysis of low-back-pain-related closed claim 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, 9th Revision diagnostic codes for uncomplicated low back pain (ULBP) and complicated low back pain (CLBP).
Care patterns with single-provider types and no referrals incurred the least charges on average for both ULBP and CLBP. When care did not include referral providers or services, for ULBP, MD and DC care was on average $465 less than MD and PT care. For CLBP, MD and DC care averaged $965 more than MD and PT care. However, when care involved referral providers or services, MD and DC care was on average $1600 less when compared to MD and PT care for ULBP and $1885 less for CLBP. Risk-adjusted charges (available 2006-2009) for patients in the middle quintile of risk were significantly less for DC care patterns.
Chiropractic care alone or DC with MD care incurred appreciably fewer charges for ULBP than MD care with or without PT care. This finding was reversed for CLBP. Adjusted charges for both ULBP and CLBP patients were significantly lower for DC patients.
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）针对腰痛治疗的护理模式所产生的医疗服务利用率和费用。
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中与腰痛相关的结案索赔数据的分析。使用国际疾病分类第九版诊断代码，从未合并的腰痛（ULBP）和复杂的腰痛（CLBP）中，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。
对于ULBP和CLBP，单一提供者类型且无转诊的护理模式平均费用最低。当护理不包括转诊提供者或服务时，对于ULBP，MD和DC护理平均比MD和PT护理少465美元。对于CLBP，MD和DC护理平均比MD和PT护理多965美元。然而，当护理涉及转诊提供者或服务时，与MD和PT护理相比，MD和DC护理对于ULBP平均少1600美元，对于CLBP少1885美元。风险处于中等五分位数的患者，DC护理模式的风险调整费用（2006 - 2009年可用）显著更低。
单独的脊椎按摩治疗或DC与MD联合护理，对于ULBP产生的费用明显少于有或没有PT护理的MD护理。对于CLBP，这一发现则相反。DC患者的ULBP和CLBP调整费用均显著更低。
