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Relative cost-effectiveness of chiropractic and medical care for acute and chronic low back pain

Mitchell Haas, DC, MA, Division of Research, Western States Chiropractic College, 2900 NE 132nd Ave., Portland, OR 97230, 503-251-5728, mhaas@wschiro.edu, Rajiv L Sharma, PhD, Department of Economics, Portland State University, P.O. Box 751, Portland, OR 97207, and Miron Stano, PhD, Department of Economics, Oakland University, School of Business Administration, Rochester, MI 48309.

This was a prospective, longitudinal, practice-based observational study. 3000 patients (1,000 MD and 2,000 DC) were recruited by 111 medical and 60 chiropractic physicians. Patients filled out a questionnaire at the baseline visit. Follow-up questionnaires were administered by mail at 2 wk, 1 mo, 3 mo, 6 mo, 12 mo, and 36 mo following enrollment. Patients answered questions about demographic, health status, psychosocial, and health services and payment characteristics. Physician questionnaires and chart audits were used to provide information on diagnostic procedures ordered and performed, primary treatment procedure used, referrals, use of physical therapy, ancillary treatment modalities, and frequency and duration of treatment.

Marginal cost-effectiveness ratios will be computed for both acute and chronic patients at short-term and long-term follow-uptime points (1 to 12 months). Costs will include both study provider and referral services. Effectiveness will be measured by Pain and functional disability improvement. Both marginal costs and effectiveness will be corrected for baseline differences between chiropractic and medical patients at baseline using multiple regression analysis. Multiple regression analysis will also be used to explore the relationship between patient outcomes and case characteristics.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

Keywords: Chiropractic, Credible Science

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Chiropractic in the Changing Health Care Environment

The 132nd Annual Meeting (November 6-10, 2004) of APHA