title: Variations in Patterns of Utilization and Charges for the Care of Headache in North Carolina, 2000-2009: A Statewide Claims' Data Analysis.
abstract: The purpose of the study was to compare patterns of utilization and charges generated by medical doctors (MDs), doctors of chiropractic (DCs), and physical therapists (PTs) for the treatment of headache in North Carolina.
  
  
  
  Retrospective analysis of claims data from the North Carolina State Health Plan for Teachers and State Employees from 2000 to 2009. Data were extracted from Blue Cross Blue Shield of North Carolina for the North Carolina State Health Plan using International Classification of Diseases, Ninth Revision, diagnostic codes for headache. The claims were separated by individual provider type, combination of provider types, and referral patterns.
  
  
  
  The majority of patients and claims were in the MD-only or MD plus referral patterns. Chiropractic patterns represented less than 10% of patients. Care patterns with single-provider types and no referrals incurred the least charges on average for headache. When care did not include referral providers or services, MD with DC care was generally less expensive than MD care with PT. However, when combined with referral care, MD care with PT was generally less expensive. Compared with MD-only care, risk-adjusted charges (available 2006-2009) for patients in the middle risk quintile were significantly less for DC-only care.
  
  
  
  Utilization and expenditures for headache treatment increased from 2000 to 2009 across all provider groups. MD care represented the majority of total allowed charges in this study. MD care and DC care, alone or in combination, were overall the least expensive patterns of headache care. Risk-adjusted charges were significantly less for DC-only care.
authors.affiliation: Professor, Office of Public Health Studies, University of Hawaii at Mānoa, Honolulu, HI. Electronic address: ehurwitz@hawaii.edu.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Hurwitz
authors.affiliation: Research Associate, Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors.forename: Maria
authors.initials: M
authors.lastname: Vassilaki
authors.affiliation: Associate Professor, Clinical and Translational Science Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY.
authors.forename: Dongmei
authors.initials: D
authors.lastname: Li
authors.affiliation: Associate Professor, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Schneider
authors.affiliation: Assistant Professor, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Stevans
authors.affiliation: Doctor of Chiropractic, Retired, Pocatello, ID.
authors.forename: Reed B
authors.initials: RB
authors.lastname: Phillips
authors.affiliation: Doctor of Chiropractic, Private Practice of Chiropractic, Wake Forest, NC.
authors.forename: Shawn P
authors.initials: SP
authors.lastname: Phelan
authors.affiliation: Doctor of Chiropractic, Private Practice of Chiropractic, Greensboro, NC.
authors.forename: Eugene A
authors.initials: EA
authors.lastname: Lewis
authors.affiliation: Doctor of Chiropractic, Private practice of chiropractic, Cary, NC.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Armstrong
mesh_terms: D002684:Chiropractic / Q000191:economics / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis; D005249:Fees and Charges / Q000706:statistics & numerical data*; D006261:Headache / Q000191:economics / Q000628:therapy*; D006801:Humans; D007345:Insurance Claim Review / Q000191:economics / Q000706:statistics & numerical data*; D026882:Manipulation, Chiropractic / Q000191:economics / Q000706:statistics & numerical data*; D008511:Medicine / Q000706:statistics & numerical data; D009657:North Carolina / Q000453:epidemiology; D010021:Osteopathic Medicine / Q000191:economics / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities / Q000191:economics / Q000706:statistics & numerical data*; D026761:Physical Therapy Specialty / Q000191:economics / Q000706:statistics & numerical data; D010820:Physicians / Q000191:economics / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies
keywords: Chiropractic; Headache; Health Services; Healthcare Costs; Medical Care; Utilization