Variations in the implementation and characteristics of chiropractic services in VA.
BACKGROUND
In 2004, the US Department of Veterans Affairs expanded its delivery of chiropractic care by establishing onsite chiropractic clinics at select facilities across the country. Systematic information regarding the planning and implementation of these clinics and describing their features and performance is lacking.


OBJECTIVE
To document the planning, implementation, key features and performance of VA chiropractic clinics, and to identify variations and their underlying causes and key consequences as well as their implications for policy, practice, and research on the introduction of new clinical services into integrated health care delivery systems.
Comparative case study of 7 clinics involving site visit-based and telephone-based interviews with 118 key stakeholders, including VA clinicians, clinical leaders and administrative staff, and selected external stakeholders, as well as reviews of key documents and administrative data on clinic performance and service delivery. Interviews were recorded, transcribed, and analyzed using a mixed inductive (exploratory) and deductive approach.


CONCLUSIONS
Interview data revealed considerable variations in clinic planning and implementation processes and clinic features, as well as perceptions of clinic performance and quality. Administrative data showed high variation in patterns of clinic patient care volume over time. A facility's initial willingness to establish a chiropractic clinic, along with a higher degree of perceived evidence-based and collegial attributes of the facility chiropractor, emerged as key factors associated with higher and more consistent delivery of chiropractic services and higher perceived quality of those services.
*Chiropractic Service, Rehabilitation and Prosthetic Services, Veterans Health Administration, Washington, DC †Chiropractic Service, VA Connecticut Healthcare System, West Haven, CT ‡Military Medical Research Program, Samueli Institute, Corona del Mar §VA Center for Implementation Practice and Research Support, VA Greater Los Angeles Healthcare System, Los Angeles ∥Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
Anthony J
AJ
Lisi
Raheleh
R
Khorsan
Monica M
MM
Smith
Brian S
BS
Mittman
D002684:Chiropractic / Q000458:organization & administration*; D006787:Hospitals, Veterans; D006801:Humans; D007407:Interviews as Topic; D009937:Organizational Objectives; D010564:Personnel, Hospital; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*