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Scenes from a Forced Marriage: Update on the Chiro-Veteran's Administration Integrated Care Program PDF Print E-mail
Written by John Weeks   

Scenes from a Forced Marriage: Data Update on the Chiro-Veteran's Administration Integrated Care Program

Summary: In 2004, the chiropractic profession and various Veterans' Service Organizations shouldered their way into the Veterans Health Administration through an act of Congress. Now, 4 years later, what do we know? How experienced are the VHA chiropractors? With what conditions are patients presenting? From which specialties are referrals originating? Via what models are the chiropractors employed and how much as they being paid? How well integrated are they with the other medical services? To what extent are they using these positions to educate others? Here is an at-a-glance chart of answers to these and other questions as reported by a team including Anthony Lisi, DC, Christine Goertz, DC, PhD and others. Lisi heads up the VHA's chiropractic program.
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for inclusion in a future Integrator.

Image
Department of Veterans Affairs
The nation's largest, governmental integrative care initiative is the chiropractic program in the Veteran's Health Administration mandated by the US Congress in 2004. The project, now in over 40 sites did not, for the most part, have a consensual beginning. Chiropractic organizations, working with Veterans Service Organizations, pushed the measure through Congress. A prior interview in the Integrator with Anthony J. Lisi, DC, who directs the program for the VHA, speaks to the early challenges. (See
Chiropractors in the Largest Health System: Anthony Lisi, DC on Integration in Veterans' Facilities, April 15, 2008.)

Image
Lisi: Lead on the study and director of the program
Lisi notes that, while the program is "centrally mandated," it is "locally implemented" and "natural variation is expected in clinical structures." So:

  • How experienced are the VHA chiropractors?
  • What conditions are patients bringing to them?
  • From which specialties are referrals originating?
  • Via what models are the chiropractors employed?
  • What conditions are they seeing?
  • How much are they earning?
  • How well integrated are they with the other medical services?
  • To what extent are they using these positions to educate others?

In the Journal of Rehabilitation Research and Development, Lisi, Christine Goertz, DC, PhD, Dana Lawrence, DC, MMedEd and Preeti Satyanarayana, MD recently published Characteristics of Veterans Health Administration chiropractors and chiropractic clinics. Here is the data snapshot of what they found. The full PDF is available here.   
_____________________________

Characteristics of the VA Chiropractic Integrative Program:
At a Glance


Total surveyed
  36
Responses
  33
 
General characteristics

   
 VA facilities with DCs in 2004
  26
 VA facilities with DCs in 2008
  36
 Veterans served in FY 2005
  4,000
 Veterans served in FY 2008
  12,000
     
Referral origination
   
Primary care
  67.6%
Pain management
  9.4%
Physiatry
  6.2%
Orthopedic surgery
  3.7%
Neurology
  3.6%
     
Integration markers
   
Often/always multidisciplinary rounds
  33%
Seldom/never multidisciplinary rounds
  48%
Often/always hospital committee work
  21%
Seldom/never hospital committee work
  64%
Often/always in-service presentations
  27%
Seldom/never in-service presentations
  45%
Often/always hospital committee work
  21%
Seldom/never hospital committee work   64%

Patient characteristics
   
 Age of typical chiro patient
   40-50 years old
 Ages of VA patients
   >60% over 60 years
 Sex of typical chiro patient
  >50% female
 Sex of VA patients
  7% female
     
Chief conditions seen
   
Low-back complaint
  47.7%
Neck complaint
  21.4%
Thoracic complaint
  9.8%
Lower-limb complaint
  7.4%
Headache
  6.4%
Upper-limb complaint
  6.2%
Wellness
  0.8%
Visceral complaint
  0.3%
     
Non-manipulative modalities used
   
Often/always patient education
  88%
Often/always exercise
  76%
Often/always physical modalities
  36%
Often/always acupressure
  30%
Often/always massage
  27%
Often/always orthoses   15%
Often/always acupuncture
  6%
Often/always nutritional supplements
  0%
Often/always homeopathy
  0%
     

 Employment characteristics
   
 VHA employees
  67% (22)
 Contracted providers
  12% (4)
 Non-compensated academic
affiliate appointees
  12% (4)
 On-station fee-based consultants
  9% (3)
 Worked 40-hr week
  58%
 Worked part-time (ave. 13.5 hr/wk)
  33%
 Based at medical centers
  88%
 Based at outpatient clinics
  6%
 Both centers and outpatient
  6%
 Were the only chiropractor
  67%
1 or 2 others DCs at hte facility
  30%
 
Gross compensation
   
$100,001-120,000
  6%
$80,001-$100,000   36%
$60,001-$80,000    21%
Up to $60,000
  27%
     
Prior practice experience of the DCs
   
16 or more years
  48%
6 to 15 years
  36%
<=5 years
  12%
Post grad. hospital-based training
  18%
Had 0-6 consultations with MDs/mo.
prior to the VA
  67%
No previous authorship of scientific
papers
  67%
     
Involvement in teaching
   
Often/always train chiropractic students
  39%
Seldom/never train chiropractic students
  58%
Often/always train other trainees
  9%
Seldom/never train other trainees
  78%


____________________________________

Comment: These data begin to create a multidimensional portrait of the VHA-chiropractic service. This is a generally very experienced bunch of practitioners, but with little prior routine co-management of care with other practitioners or in hospital or health system environments. Given the continuous campaign from the American Chiropractic Association and supporters like US Senator Patty Murray (D-WA) to broaden the service, hopefully the teaching component of these practitioners' responsibilities will expand. Here's hoping there will be additional qualitative analysis of patient experience and of practitioner experience of the service, and that analysis of practitioner experience extends to both chiropractors and the healthcare staff on whose turf the chiropractors are the newcomers. (An abstract of an initial case series is here.)

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for inclusion in a future Integrator.


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