title: Effects of a managed chiropractic benefit on the use of specific diagnostic and therapeutic procedures in the treatment of low back and neck pain.
abstract: OBJECTIVE
  The aim of this study was to measure the effects of a managed chiropractic benefit on the rates of specific diagnostic and therapeutic procedures for the treatment of back pain and neck pain.
  
  
  METHODS
  This study is a retrospective analysis of claims data from a managed-care health plan over a 4-year period. The use rates of advanced imaging, surgery, inpatient care, and plain-film radiographs were compared between employer groups with and without a chiropractic benefit.
  
  
  RESULTS
  For patients with low back pain, the use rates of all 4 studied procedures were lower in the group with chiropractic coverage. On a per-episode basis, the rates in the group with coverage were reduced by the following: surgery (-32.1%); computed tomography (CT)/magnetic resonance imaging (MRI) (-37.2%); plain-film radiography (-23.1%); and inpatient care (-40.1%). On a per-patient basis, the rates were reduced by the following: surgery (-13.7%); CT/MRI (-20.3%); plain-film radiography (-2.2%); and inpatient care (-24.8%). For patients with neck pain, the use rates were reduced per episode in the group with chiropractic coverage as follows: surgery (-49.4%); CT/MRI (-45.6%); plain-film radiography (-36.0%); and inpatient care (-49.5%). Per patient, the rates were surgery (-31.1%); CT/MRI (-25.7%); plain-film radiography (-12.5%); and inpatient care (31.1%). All group differences were statistically significant.
  
  
  CONCLUSIONS
  For the treatment of low back and neck pain, the inclusion of a chiropractic benefit resulted in a reduction in the rates of surgery, advanced imaging, inpatient care, and plain-film radiographs. This effect was greater on a per-episode basis than on a per-patient basis.
authors.affiliation: Health Services Research, American Specialty Health, San Diego, CA 92101, USA. craign@ashn.com
authors.forename: Craig F
authors.initials: CF
authors.lastname: Nelson
authors.forename: R Douglas
authors.initials: RD
authors.lastname: Metz
authors.forename: Thomas
authors.initials: T
authors.lastname: LaBrot
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015897:Comorbidity; D005260:Female; D006264:Health Benefit Plans, Employee / Q000145:classification*; D006801:Humans; D007342:Insurance Benefits / Q000145:classification*; D007345:Insurance Claim Review; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D008297:Male; D026882:Manipulation, Chiropractic / Q000706:statistics & numerical data*; D019547:Neck Pain / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D011859:Radiography; D012189:Retrospective Studies