Utilization and costs of lumbar and full spine radiography by Ontario chiropractors from 1994 to 2001
Received 14 May 2008; accepted 20 March 2009. published online 18 May 2009.
Abstract
Background context
In Ontario, chiropractors see one-third of patients who seek care for low back pain. Previous studies suggest that chiropractors have high utilization rates of lumbar and full spine radiography. There has been a proliferation of evidence-based guidelines recommending that plain film radiography be used only to assess high-risk patients with low back pain. Evidence for the use of full spine radiography, except for the evaluation of scoliosis is lacking. It is uncertain what impact the growing evidence against their use has had on radiography utilization by Ontario chiropractors.
Purpose
To describe the annual costs and use of lumbar and full spine plain film radiography among Ontario chiropractors between 1994 and 2001.
Study design/setting
Time-trend analysis of radiography utilization by Ontario chiropractors.
Patient sample
Chiropractic claims data submitted to the Ontario Health Insurance Plan or the Workplace Safety & Insurance Board from 1994/1995 to 2000/2001.
Outcome measures
Change in the annual cost and proportion of claimants receiving lumbar and full spine radiography.
Methods
Time-trend analysis of chiropractic claims submitted to the Ontario Health Insurance Plan (OHIP) or Workplace Safety & Insurance Board (WSIB) from 1994/1995 to 2000/2001 fiscal years.
Results
During the 7-year period, the proportion of OHIP claimants receiving lumbar spine radiography decreased from 4.54% to 3.25% and for full spine radiography from 3.87% to 3.04%. For WSIB claimants, lumbar spine radiography deceased from 6.49% to 3.30% of claimants and full spine radiography from 1.51% to 0.94%. OHIP payments for lumbar spine radiography decreased 12.7% to $562,944, whereas full spine radiography payments decreased 5.3% to $1,071,408. WSIB lumbar and full spine radiography payments decreased 44.2% and 34.3% to $31,202 and $11,713 respectively.
Conclusions
Claims data from the two largest third-party payers of chiropractic services in Ontario, suggest that lumbar and full spine radiography, and their associated costs decreased steadily between 1994 and 2001.
aRehabilitation Solutions, University Health Network, Toronto, ON, Canada
bCentre for Research Expertise in Improved Disability Outcomes (CREIDO), University Health Network, Fell Pavilion 4-132, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada
cInstitute for Work & Health, University of Toronto, ON, Canada
dDepartment of Public Health Sciences, University of Toronto, ON, Canada
eDepartment of Medicine University of Toronto, ON, Canada
fDivision of Rheumatology, University of Toronto, ON, Canada
gClinical Decision-Making and Health Care Division, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
Corresponding author. Centre for Research Expertise in Improved Disability Outcomes, Toronto Western Hospital, Fell Pavilion 4-132, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada. Tel.: (416) 603-5800x3326; fax: (416) 603-5150.
FDA device/drug status: not applicable.
Author disclosures: none.
The principal investigator's training was supported by a Canadian Institute for Health Research Fellowship Award in partnership with the Canadian Memorial Chiropractic College and the Canadian Chiropractic Research Foundation. This research was also supported by the Ontario Ministry of Health and Long Term Care through the Special Chiropractic Research Fund.
ABSTRACT