title: Chiropractic episodes and the co-occurrence of chiropractic and health services use among older Medicare beneficiaries.
abstract: OBJECTIVE
  The purpose of this study was to define and characterize episodes of chiropractic care among older Medicare beneficiaries and to evaluate the extent to which chiropractic services were used in tandem with conventional medicine.
  
  
  METHODS
  Medicare Part B claims histories for 1991 to 2007 were linked to the nationally representative survey on Assets and Health Dynamics among the Oldest Old baseline interviews (1993-1994) to define episodes of chiropractic sensitive care using 4 approaches. Chiropractic and nonchiropractic patterns of service use were examined within these episodes of care. Of the 7447 Assets and Health Dynamics among the Oldest Old participants, 971 used chiropractic services and constituted the analytic sample.
  
  
  RESULTS
  There were substantial variations in the number and duration of episodes and the type and volume of services used across the 4 definitions. Depending on how the episode was constructed, the mean number of episodes per chiropractic user ranged from 3.74 to 23.12, the mean episode duration ranged from 4.7 to 28.8 days, the mean number of chiropractic visits per episode ranged from 0.88 to 2.8, and the percentage of episodes with co-occurrent use of chiropractic and nonchiropractic providers ranged from 4.9% to 10.9% over the 17-year period.
  
  
  CONCLUSIONS
  Treatment for back-related musculoskeletal conditions was sought from a variety of providers, but there was little co-occurrent service use or coordinated care across provider types within care episodes. Chiropractic treatment dosing patterns in everyday practice were much lower than that used in clinical trial protocols designed to establish chiropractic efficacy for back-related conditions.
authors.affiliation: Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA 52242, USA. Paula-Weigel@uiowa.edu
authors.forename: Paula A M
authors.initials: PA
authors.lastname: Weigel
authors.forename: Jason M
authors.initials: JM
authors.lastname: Hockenberry
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Bentler
authors.forename: Brian
authors.initials: B
authors.lastname: Kaskie
authors.forename: Fredric D
authors.initials: FD
authors.lastname: Wolinsky
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002684:Chiropractic / Q000706:statistics & numerical data*; D003131:Combined Modality Therapy; D017050:Episode of Care; D005260:Female; D015577:Geriatric Assessment; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D017116:Low Back Pain / Q000453:epidemiology / Q000628:therapy; D016345:Medicare Part B / Q000191:economics / Q000706:statistics & numerical data*; D009140:Musculoskeletal Diseases / Q000453:epidemiology / Q000628:therapy*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012737:Sex Factors; D016896:Treatment Outcome; D014481:United States