المؤلفون: Srinivasan, Roshini, Rodgers-Melnick, Samuel, Rivard, Rachael, Kaiser, Christine, Vincent, David, Adan, Francoise, Dusek, Jeffery

المصدر: PLoS ONE. 19(5)

مصطلحات موضوعية: Humans, Female, Male, Patient Reported Outcome Measures, Middle Aged, Adult, Retrospective Studies, Integrative Medicine, Surveys and Questionnaires, Outpatients, Aged

الوصف: OBJECTIVE: To investigate the feasibility of pre- and post-encounter patient-reported outcome (PRO) measure collection within an outpatient integrative health and medicine (IHM) clinic and to characterize factors associated with successful completion. METHODS: We conducted a retrospective review of 27,464 outpatient IHM encounters including 9,520 chiropractic; 8,237 acupuncture; 5,847 massage; 2,345 IHM consultation; and 1,515 osteopathic manipulation treatment encounters at four clinics offering IHM over 18 months. Patients were asked to complete paper questionnaires rating pain, anxiety, and stress from 0-10 immediately pre- and post-encounter. Generalized linear mixed effect regression models were used to examine the relationship between demographic, clinical, and operational covariates and completing (1) pre-encounter and (2) paired (i.e., pre and post) PROs. RESULTS: Patients (N = 5587, mean age 49 years, 74% white, 77% female) generally presented for musculoskeletal conditions (81.7%), with a chief complaint of pain (55.1%). 21,852 (79.6%) encounters were among patients who completed pre-encounter PROs; 11,709/21,852 (53.6%) completed subsequent post-encounter PROs. Odds of PRO completion were more impacted by provider, operational, and clinical-level factors than patient factors. Covariates associated with increased odds of pre-encounter PRO completion included being female, having additional IHM encounters, and having a pain or anxiety complaint. Covariates associated with increased odds of paired PRO completion included being aged 31-40 vs. 51-60 years and having additional IHM encounters. CONCLUSION: Implementing a paper-based PRO collection system in outpatient IHM is feasible; however, collecting post-encounter PROs was challenging. Future endeavors should leverage the electronic health record and patient portals to optimize PRO collection and engage patients and clinical providers.

وصف الملف: application/pdf

URL الوصول: https://escholarship.org/uc/item/4cp189qt
https://escholarship.org/content/qt4cp189qt/qt4cp189qt.pdf

المؤلفون: Herman, Patricia M, Yuan, Anita H, Cefalu, Matthew S, Chu, Karen, Zeng, Qing, Marshall, Nell, Lorenz, Karl A, Taylor, Stephanie L

المصدر: PLOS ONE. 14(6)

مصطلحات موضوعية: Complementary and Integrative Health, Clinical Research, Health Services, Chronic Pain, Pain Research, Good Health and Well Being, Adolescent, Adult, Cohort Studies, Complementary Therapies, Female, Humans, Integrative Medicine, Linear Models, Male, Middle Aged, Musculoskeletal Pain, United States, Veterans, Young Adult, General Science & Technology

الوصف: ObjectivesTo estimate the cost-effectiveness to the US Veterans Health Administration (VA) of the use of complementary and integrative health (CIH) approaches by younger Veterans with chronic musculoskeletal disorder (MSD) pain.PerspectiveVA healthcare system.MethodsWe used a propensity score-adjusted hierarchical linear modeling (HLM), and 2010-2013 VA administrative data to estimate differences in VA healthcare costs, pain intensity (0-10 numerical rating scale), and opioid use between CIH users and nonusers. We identified CIH use in Veterans' medical records through Current Procedural Terminology, VA workload tracking, and provider-type codes.ResultsWe identified 30,634 younger Veterans with chronic MSD pain as using CIH and 195,424 with no CIH use. CIH users differed from nonusers across all baseline covariates except the Charlson comorbidity index. They also differed on annual pre-CIH-start healthcare costs ($10,729 versus $5,818), pain (4.33 versus 3.76), and opioid use (66.6% versus 54.0%). The HLM results indicated lower annual healthcare costs (-$637; 95% CI: -$1,023, -$247), lower pain (-0.34; -0.40, -0.27), and slightly higher (less than a percentage point) opioid use (0.8; 0.6, 0.9) for CIH users in the year after CIH start. Sensitivity analyses indicated similar results for three most-used CIH approaches (acupuncture, chiropractic care, and massage), but higher costs for those with eight or more CIH visits.ConclusionsOn average CIH use appears associated with lower healthcare costs and pain and slightly higher opioid use in this population of younger Veterans with chronic musculoskeletal pain. Given the VA's growing interest in the use of CIH, further, more detailed analyses of its impacts are warranted.

وصف الملف: application/pdf

URL الوصول: https://escholarship.org/uc/item/1sr8s4fm