Article
Impact of guideline dissemination strategies among chiropractors enlisted in a Provider Network in the United States: Interrupted time series with segmented regression analysis
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Published: | July 10, 2012 |
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Background: Wide regional variations in spine x-ray ordering persist among chiropractors. Distribution of educational materials is generally effective for improving appropriate care such as ordering spine x-rays, but little is known about its impact among North American chiropractors.
Objective: To evaluate the impact of web-based dissemination of imaging guidelines in reducing chiropractors use of spine x-rays.
Methods: Interrupted time series to evaluate the effect of guidelines dissemination on use of spine x-ray. Administrative claims data were extracted between January 2006 and December 2010. The intervention was delivered in April 2008 among chiropractors enlisted with a large network of complementary care providers across the US. Sensitivity analysis considered the effect of two quality improvement (educational) strategies targeting high x-ray users.
Results: A total of 136,785 spine x-rays claims were paid throughout the network. Utilization rate decreased steadily over the five year period. Time series analysis revealed a significant change in the level of spine x-rays ordering soon after introduction of the guidelines (-0.01; CI=-0.01,-0.002; p=0.01), but no change in slopes of the regression lines. The monthly mean rate of spine x-rays with 5 days of initial visit per new patient exams decreased by 10 per 1000, a 5.26% relative decrease after dissemination of the guidelines. Controlling for two educational strategies did not change results.
Discussion: Passive guideline dissemination was associated with a stepwise reduction in spine x-ray utilization among network chiropractors.
Implications for guideline developers/users: Web-based guideline disseminations strategies may have significant population health and economic impacts in large provider networks.