Measuring Clinical Outcomes in Your Practice
TECHNIQUE
By Murray P. Naditch, Ph.D.
There is a tectonic movement in healthcare that will profoundly affect your practice. It’s the paradigm shift from fee-for-service to value-based reimbursement.1
According to the American Chiropractic Association: “there is no better time than now for individual doctors of chiropractice to become more familiar with the outcomes approach to care— today it may be a choice, but tomorrow it could very well be a requirement for reimbursement.”2
METHOD
The study was conducted at the Pure Balance Body & Mind Center in Glendale, California.
Patients were weighed weekly. Blood pressure was measured at four intervals during treatment. Patient demographics were coded including age, gender, and patient motivation for treatment.
Patients received some combination of:
1. Spinal adjustment.
2. Nutritional counseling for weight loss/healthy living.
3. Supplements including amino acids, detox complex, antioxidants, conjugated linolenic acid, Q10, selenium, bromelian, serra peptase as well as guaraña and konjac root.
4. Leander Flexion Table.
5. Ultrasound.
6. Manual therapy.
7. Electronic muscular stimulation.
8. Stimulation belt exercises.
9. Neuro-musculo-skelatal chair designed to strengthen/ stimulate abdominal core muscles.
10. Stand-on vibration exercises.
11. Red light sauna.
12.Home therapy exercises.
SAMPLE
Sixty patient charts were selected at random from patients who had received treatment during the last two years. Four patients did not complete the program, consequently fifty-six patient records were used in the analysis.
RESULTS
Figure 1 shows Weight Lost per Session over treatment.
Figure 1
Weight Lost per Session over the Course of Treatment
Weight Lost per Session (n=56)
■ "It’s the paradigm shift from fee-for-service to value-based reimbursement. J J
Patients experienced a steady weight loss. These fifty-six patients lost a total of more than 1,300 lbs in 10 weeks.
The program worked equally well for males and females. Females lost an average of 23 lbs. Males lost an average of 25 lbs.
Patients were divided into high, medium, and low age groups. Table 1 shows weight lost by age group. Patients lost weight regardless of age. High initial weight patients lost more weight than mediumor low-weight patients.
Table 1
Weight Lost by Initial Weight
Initial Weight Range Lbs Weight Lost
High 209-313 32
Medium 185 - 199 25
Low 141 - 177 22
Table 2 shows changes in blood pressure from the beginning to the end of treatment. Blood pressure was measured at four intervals. Systolic and diastolic blood pressure was reduced during treatment.
Table 2
Change in Systolic & Diastolic Blood Pressure During Treatment
Treatment Systolic Diastolic Interval
1 135.9 84.6
2 134.0 83.3
3 130.3 78.3
4 128.2 77.6
Change
Total 7.7 7.0
Some patients came to the clinic for pain-related chiropractic problems, whereas others came primarily to lose weight. Patients lost approximately the same amount of weight whether they came to the clinic for chiropractic reasons or for weight reduction. Patients motivated to lose weight lost 21.1 lbs and those motivated for chiropractic reasons lost 24.8 lbs.
DISCUSSION
Patients in the study experienced significant drops in both weight and blood pressure regardless of gender, age, initial weight, or motivation for treatment.
Patients lost an average of 23.5 lbs in ten sessions. That much weight pulls the body forward, strains low back muscles, throws off posture, and leads to more back problems and pain.
This magnitude of weight lost and decreases in blood pressure significantly reduce risk for heart disease, stroke, diabetes, dementia, and cancer.3
These results were drawn from retrospective data existing in patient files. Consequently, no follow-up data was included. Conclusions can be drawn about weight loss from the beginning to the end of the program, but not about the long-term effects of the program on weight control.
A follow-up study that includes follow-up data as well as additional outcome variables including pain and quality of life aie in progress.
References:
1. www.acatoday.org/acanews.
2. Shaw, G., Taking an Offense on Outcomes Assessment. American Chiropractic Association, http://www.acatoday.org/content -css. cfm?CID=2406.
3. http://www.nhlbi.nih.gov/health/health-topics/topics/obe/risks.
Murray Naditch, PhD, has measured health care outcomesin more than 300 hospitals and behavioral healthcare clinics. He is currently CEO at Clinical Outcome Systems™ LLC. He can be contacted at 877-797-6560.
