gms | German Medical Science

G-I-N Conference 2012

Guidelines International Network

22.08 - 25.08.2012, Berlin

Impact of guideline dissemination strategies among chiropractors enlisted in a Provider Network in the United States: Interrupted time series with segmented regression analysis

Meeting Abstract

  • A. Bussieres - University of Ottawa, Université du Québec à Trois - Rivieres, Trois-Rivieres, Canada
  • J. Grimshaw - Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
  • T. Ramsay - Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
  • A. Sales - School of Nursing, University of Michigan, Michigan, United States
  • S. Hilles - American Specialty Health Network, Inc, San Dieago, United States

Guidelines International Network. G-I-N Conference 2012. Berlin, 22.-25.08.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocO60

doi: 10.3205/12gin092, urn:nbn:de:0183-12gin0923

Veröffentlicht: 10. Juli 2012

© 2012 Bussieres et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



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.