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