title: Clinical utilization and cost outcomes from an integrative medicine independent physician association: an additional 3-year update.
abstract: OBJECTIVE
  Our initial report analyzed clinical and cost utilization data from the years 1999 to 2002 for an integrative medicine independent physician association (IPA) whose primary care physicians (PCPs) were exclusively doctors of chiropractic. This report updates the subsequent utilization data from the IPA for the years 2003 to 2005 and includes first-time comparisons in data points among PCPs of different licensures who were oriented toward complementary and alternative medicine (CAM).
  
  
  METHODS
  Independent physician association-incurred claims and stratified random patient surveys were descriptively analyzed for clinical utilization, cost offsets, and member satisfaction compared with conventional medical IPA normative values. Comparisons to our original publication's comparative blinded data, using nonrandom matched comparison groups, were descriptively analyzed for differences in age/sex demographics and disease profiles to examine sample bias.
  
  
  RESULTS
  Clinical and cost utilization based on 70,274 member-months over a 7-year period demonstrated decreases of 60.2% in-hospital admissions, 59.0% hospital days, 62.0% outpatient surgeries and procedures, and 85% pharmaceutical costs when compared with conventional medicine IPA performance for the same health maintenance organization product in the same geography and time frame.
  
  
  CONCLUSIONS
  During the past 7 years, and with a larger population than originally reported, the CAM-oriented PCPs using a nonsurgical/nonpharmaceutical approach demonstrated reductions in both clinical and cost utilization when compared with PCPs using conventional medicine alone. Decreased utilization was uniformly achieved by all CAM-oriented PCPs, regardless of their licensure. The validity and generalizability of this observation are guarded given the lack of randomization, lack of statistical analysis possible, and potentially biased data in this population.
authors.affiliation: Alternative Medicine Integration Group, LP, Highland Park, Ill 60035, USA. rsarnat@amibestmed.com <rsarnat@amibestmed.com>
authors.forename: Richard L
authors.initials: RL
authors.lastname: Sarnat
authors.forename: James
authors.initials: J
authors.lastname: Winterstein
authors.forename: Jerrilyn A
authors.initials: JA
authors.lastname: Cambron
mesh_terms: D000328:Adult; D017677:Age Distribution; D000553:Ambulatory Care / Q000706:statistics & numerical data; D002641:Chicago; D002648:Child; D002684:Chiropractic / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007193:Independent Practice Associations / Q000191:economics* / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data