EXPANDING EVIDENCE-BASED TECHNOLOGY ASSESSMENT FOR COVERAGE IN WASHINGTON STATE.

Objectives: We describe a new evidence-based method for screening and evaluating emerging medical technologies. Washington State agencies, under legislative direction, have granted authority to its agency Medical Directors and policy leaders to make coverage decisions on medical technologies using a "dossier" process. The dossier process is employed when technology advocates or manufacturers request Washington State healthcare purchasers to pay for new and emerging technologies.

Improving quality, preventing disability and reducing costs in workers' compensation healthcare: a population-based intervention study.

Background: Problems of poor quality and high costs are worse in the workers' compensation system than in the general medical care system, yet relatively little work has been done to improve performance in workers' compensation healthcare.

Objective: To evaluate the effect of a quality improvement intervention that provided financial incentives to providers to encourage adoption of best practices, coupled with organizational support and care management activities, aimed at reducing work disability for patients treated within the Washington State workers' compensation system.

Research Design: Prospective nonrandomized intervention study with nonequivalent comparison group using difference-in-difference models to estimate the effect of the intervention.

Chiropractic management of low back pain and low back-related leg complaints: a literature synthesis.

Objectives: The purpose of this project was to review the literature for the use of spinal manipulation for low back pain (LBP).

Methods: A search strategy modified from the Cochrane Collaboration review for LBP was conducted through the following databases: PubMed, Mantis, and the Cochrane Database. Invitations to submit relevant articles were extended to the profession via widely distributed professional news and association media.

Measuring work disability: what can administrative data tell us about patient outcomes?

Objective: The purpose of this study was to assess the association between administrative measures of work disability and self-reported work, pain, and functional status.

Methods: We conducted baseline and follow-up interviews to assess pain, functional status, work status, and demographic factors in workers with low back injuries, carpal tunnel syndrome, and upper and lower extremity fractures. Administrative measures of work disability were obtained from the Washington State Department of Labor and Industries.

Chiropractic's current state: impacts for the future.

The chiropractic profession is currently facing a shift in practice and health care environments. This editorial reflects on the current state of the profession and suggests that the profession should move from the thinking and practice styles of the past that primarily attempted to prove patient care and practice to a more productive approach that strives to improve patient care and practice. The following primary areas that require attention are discussed: (1) evidence-based and best practices-oriented research priorities; (2) constructive engagement of the greater health care system; and (3) successful ethical business models.

Health services research related to chiropractic: review and recommendations for research prioritization by the chiropractic profession.

Purpose: This project updates a previous effort to inventory health services research conducted on chiropractic and makes recommendations for a subsequent research agenda. A qualitative review of social sciences, medical, chiropractic, and health services research literature regarding chiropractic was done with emphasis on research published since the initial health services research agenda effort in 1995. This work informed development of updated health services research recommendations.

Characteristics of chiropractic practitioners, patients, and encounters in Massachusetts and Arizona.

Objective: To describe chiropractic care using data collected at the time of each patient visit.

Methods: Random samples of chiropractors licensed in Arizona and Massachusetts were recruited to participate in interviews about their training, demographics, and practice characteristics. Interviewees were then recruited to record information about patient condition, evaluation, care, and visit disposition on 20 consecutive patient visits.

A communitywide intervention to improve outcomes and reduce disability among injured workers in Washington State.

One pressing challenge facing the U.S. health care system is the development of effective policies and clinical management strategies to address deficiencies in health care quality.

Patient satisfaction, treatment experience, and disability outcomes in a population-based cohort of injured workers in Washington State: implications for quality improvement.

Objective: To determine what aspects of patient satisfaction are most important in explaining the variance in patients' overall treatment experience and to evaluate the relationship between treatment experience and subsequent outcomes.

Data Sources And Setting: Data from a population-based survey of 804 randomly selected injured workers in Washington State filing a workers' compensation claim between November 1999 and February 2000 were combined with insurance claims data indicating whether survey respondents were receiving disability compensation payments for being out of work at 6 or 12 months after claim filing.

Study Design: We conducted a two-step analysis.

Use of attorneys and appeal filing in the Washington State workers' compensation program: does patient satisfaction matter?

Learning Objectives: Specify the frequency with which injured workers in Washington State's compensation system retained an attorney or filed an appeal, and the personal and job-related correlates of these actions. Analyze the relationship between workers' legal actions and their satisfaction in two domains: how well the claim was managed administratively, and how well the worker and claim manager communicated with one another. Characterize the relationship between retaining an attorney and long-term disability.

Characteristics of visits to licensed acupuncturists, chiropractors, massage therapists, and naturopathic physicians.

Background: Despite growing popularity of complementary and alternative medical (CAM) therapies, little is known about the patients seen by CAM practitioners. Our objective was to describe the patients and problems seen by CAM practitioners.

Methods: We collected data on 20 consecutive visits to randomly sampled licensed acupuncturists, chiropractors, massage therapists, and naturopathic physicians practicing in Arizona, Connecticut, Massachusetts, and Washington.

Characteristics of licensed acupuncturists, chiropractors, massage therapists, and naturopathic physicians.

Background: Despite the growing popularity of complementary and alternative medical (CAM) therapies, little is known about the professionals who provide them. Our objective was to describe the characteristics of the four largest groups of licensed CAM providers in the United States and to compare them with the characteristics of conventional physicians.

Methods: Random statewide samples of licensed acupuncturists, chiropractors, massage therapists, and naturopathic physicians living in Arizona, Connecticut, Massachusetts and Washington were interviewed by telephone.

Improving the quality of occupational health care in Washington State: new approaches to designing community-based health care systems.

The need for concerted action to improve quality was stressed in the recent Institute of Medicine report, Crossing the Quality Chasm: A New Health Care System for the 21st Century. This article describes an innovative community-based delivery system initiative designed to improve quality and health outcomes for occupational health conditions. Known as the Occupational Health Services (OHS) project, this Washington State initiative focuses on three targeted conditions: low back sprain, carpal tunnel syndrome, and fractures.

Improving the quality of workers' compensation health care delivery: the Washington State Occupational Health Services Project.

This article has summarized research and policy activities undertaken in Washington State over the past several years to identify the key problems that result in poor quality and excessive disability among injured workers, and the types of system and delivery changes that could best address these problems in order to improve the quality of occupational health care provided through the workers' compensation system. Our investigations have consistently pointed to the lack of coordination and integration of occupational health services as having major adverse effects on quality and health outcomes for workers' compensation. The Managed Care Pilot Project, a delivery system intervention, focused on making changes in how care is organized and delivered to injured workers.

Application of incremental change strategies in chiropractic and multidisciplinary clinical settings for quality improvement.

Care for low back pain remains a clinical enigma. Its high prevalence and cost to the system warrants attention for improvement. Although, no major recent clinical breakthroughs for resolving back pain have emerged, reducing unnecessary tests, eliminating useless or harmful practices, preventing care dependence, and enhancing coping skills can be useful goals for improving patient outcomes.

Endotoxin priming of the cyclooxygenase-2-thromboxane axis in isolated rat lungs.

Enhanced prostanoid generation has been implicated in vascular abnormalities occurring during endotoxemia and sepsis, and the lung is particularly prone to such events. Prostanoids are generated from arachidonic acid (AA) via cyclooxygenase (COX)-1 or -2, both isoenzymes recently demonstrated to be expressed in different lung cell types. Upregulation of COX may underlie the phenomenon that endotoxin [lipopolysaccharide (LPS)]-exposed lungs show markedly enhanced vasoconstrictor responses to secondarily applied stimuli (priming).

Comparison of work and time estimates by chiropractic physicians with those of medical and osteopathic providers.

Background: Resource-based relative value scales (RBRVS) have become a standard method for identifying costs and determining reimbursement for physician services. Development of RBRVS systems and methods are reviewed, and the RBRVS concept of physician "work" is defined.

Objective: Results of work and time inputs from chiropractic physicians are compared with those reported by osteopathic and medical specialties.

Health services research related to chiropractic: review and recommendations for research prioritization by the chiropractic profession.

Purpose: This project was part of a national, federally sponsored effort to create a prioritized research agenda for the chiropractic profession. An overview (and a separate comprehensive annotated bibliography) of recent social sciences, medical, chiropractic and health services research literature regarding chiropractic is presented. Based on this information, key research questions and issues were identified in the areas of health services research, practice environments and account ability/quality management.

Establishment of total and intraservice work by chiropractic physicians in providing spinal manipulative therapy and evaluation and management services.

Objective: To develop and test a self-report survey instrument that measures the work performed by chiropractors in the delivery of evaluation and management (E/M) services and spinal manipulative therapy (SMT). Work is one leg of a triad used to develop Resource-Based Relative Values Scales (RBRVS) for physician reimbursement.

Design: Reliability study modeled after a tool designed and tested by economists at Harvard University School of Public Health in the development of relative values scales for physician reimbursement.

The impact of health policy on chiropractic.

Objective: The chiropractic profession has traditionally had little or no direct influence on health policy. Conversely, every chiropractor is impacted daily by health policy decisions promulgated by government agencies, health purchasers, managed care organizations and others. This discussion provides an overview of health policy constituencies important to chiropractors, reviews processes currently being used to assess health care technology and develop policy and offers strategies for the profession to more actively engage in constructive policy development.

Resource-Based Relative Value Scales: impacts and recommendations relative to chiropractic practice.

Purpose: The American health care financing and delivery system is changing at a rapid pace. As part of recent reform of payment systems for physician services, Medicare has adopted a resource-based relative value scale (RBRVS) that is becoming a national standard. Research has now documented characteristics of physicians' work and the overhead for providing specific health services for most medical specialties and disciplines.

The descriptive profile of low back pain patients of field practicing chiropractors contrasted with those treated in the clinics of west coast chiropractic colleges.

Objective: To compare the demographic and clinical characteristics of low back pain patients from chiropractic college clinics and private practice settings on the west coast of the United States.

Design And Setting: A survey analysis of consecutive new patients in a specified time frame from multiple private office settings contrasted with a previous survey of consecutive new patients in a similar time frame from chiropractic college clinics.

Patients: In the private practice setting, new patients were selected on a consecutive basis as subjects for the study.