A Systems Approach for Assessing Low Back Pain Care Quality in Veterans Health Administration Chiropractic Visits: A Cross-Sectional Analysis

IF 1.2 4区医学 Q4 HEALTH CARE SCIENCES & SERVICES

Journal of Manipulative and Physiological Therapeutics Pub Date : 2023-03-01 DOI:10.1016/j.jmpt.2023.11.002

Ryan D. Muller DC, MS , Sarah E. Graham DC , Xiwen Zhao MSPH , Lori A. Bastian MD, MPH , Anna R. Sites MSN, RN , Kelsey L. Corcoran DC , Anthony J. Lisi DC

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引用次数: 0

Abstract

Objective

The purpose of this study was to explore a systemwide process for assessing components of low back pain (LBP) care quality in Veterans Health Administration (VHA) chiropractic visits using electronic health record (EHR) data.

Methods

We performed a cross-sectional quality improvement project. We randomly sampled 1000 on-station VHA chiropractic initial visits occurring from October 1, 2017, to September 30, 2018, for patients with no such visits within the prior 12 months. Characteristics of LBP visits were extracted from VHA national EHR data via structured data queries and manual chart review. We developed quality indicators for history and/or examination and treatment procedures using previously published literature and calculated frequencies of visits meeting these indicators. Visits meeting our history and/or examination and treatment indicators were classified as “high-quality” visits. We performed a regression analysis to assess associations between demographic/clinical characteristics and visits meeting our quality criteria.

Results

There were 592 LBP visits identified. Medical history, physical examination, and neurologic examination were documented in 76%, 77%, and 63% of all LBP visits, respectively. Recommended treatments, such as any manipulation, disease-specific education/advice, and therapeutic exercise, occurred in 75%, 69%, and 40% of chronic visits (n = 383), respectively. In acute/subacute visits (n = 37), any manipulation (92%), manual soft tissue therapy (57%), and disease-specific advice/education (54%) occurred most frequently. Female patients and those with a neck pain comorbid diagnosis were significantly less likely to have a “high-quality” visit, while other regression associations were non-significant.

Conclusion

This study explored a systemwide process for assessing components of care quality in VHA chiropractic visits for LBP. These results produced a potential framework for uniform assessment of care quality in VHA chiropractic visits for LBP and highlight potential areas for improvements in LBP care quality assessments.

查看原文本刊更多论文

退伍军人健康管理局脊骨神经科门诊中评估腰背痛护理质量的系统方法：横断面分析

目的：本研究的目的是探索一种全系统的过程，利用电子健康记录（EHR）数据评估退伍军人健康管理局（VHA）脊椎指压治疗就诊中腰痛（LBP）护理质量的组成部分。方法实施横断面质量改进工程。我们随机抽取了1000例在2017年10月1日至2018年9月30日期间进行的现场VHA脊椎指压治疗首次就诊的患者，这些患者在过去12个月内没有进行过此类就诊。通过结构化数据查询和手工图表审查，从VHA国家电子病历数据中提取LBP就诊特征。我们利用先前发表的文献和计算出的符合这些指标的就诊频率，为病史和/或检查和治疗程序制定了质量指标。符合我们的病史和/或检查和治疗指标的访问被归类为“高质量”访问。我们进行了回归分析，以评估人口学/临床特征与符合质量标准的就诊之间的关系。结果共发现592例LBP就诊。在所有LBP就诊中，分别有76%、77%和63%记录了病史、体格检查和神经系统检查。推荐的治疗方法，如任何手法、疾病特异性教育/建议和治疗性运动，分别出现在75%、69%和40%的慢性就诊中（n = 383）。在急性/亚急性就诊（n = 37）中，最常见的是任何手法（92%）、手动软组织治疗（57%）和疾病特异性建议/教育（54%）。女性患者和颈部疼痛合并症患者进行“高质量”就诊的可能性明显较低，而其他回归关联则不显著。结论：本研究探索了一个系统范围的过程，用于评估VHA脊椎指压治疗腰痛就诊的护理质量组成部分。这些结果产生了一个潜在的框架，用于统一评估VHA脊椎指压治疗腰痛的护理质量，并突出了腰痛护理质量评估的潜在改进领域。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Manipulative and Physiological Therapeutics 医学-康复医学

CiteScore

3.00

自引率

7.70%

发文量

审稿时长

29 weeks

期刊介绍： The Journal of Manipulative and Physiological Therapeutics (JMPT) is an international and interdisciplinary journal dedicated to the advancement of conservative health care principles and practices. The JMPT is the premier biomedical publication in the chiropractic profession and publishes peer reviewed, research articles and the Journal''s editorial board includes leading researchers from around the world. The Journal publishes original primary research and review articles of the highest quality in relevant topic areas. The JMPT addresses practitioners and researchers needs by adding to their clinical and basic science knowledge and by informing them about relevant issues that influence health care practices.