Implementation of the Primary Spine Care Model in a Multi-Clinician Primary Care Setting: An Observational Cohort Study

J Manipulative Physiol Ther. 2020 Sep;43(7):667-674. doi: 10.1016/j.jmpt.2020.05.002. Epub 2020 Aug 31.


Objective: The objective of this investigation was to compare the value of primary spine care (PSC) with usual care for management of patients with spine-related disorders (SRDs) within a primary care setting.

Methods: We retrospectively examined existing patient encounter data at 3 primary care sites within a multi-clinic health system. Designated clinicians serve in the role as PSC as the initial point of contact for spine patients, coordinate, and follow up for the duration of the episode of care. A PSC may be a chiropractor, physical therapist, or medical or osteopathic physician who has been trained to provide primary care for patients with SRDs. The PSC model of care had been introduced at site I (Lebanon, New Hampshire); sites II (Bedford, New Hampshire) and III (Nashua, New Hampshire) served as control sites where patients received usual care. To evaluate cost outcomes, we employed a controlled quasi-experimental design for analysis of health claims data. For analysis of clinical outcomes, we compared clinical records for PSC at site I and usual care at sites II and III, all with reference to usual care at site I. We examined clinical encounters occurring over a 24-month period, from February 1, 2016 through January 31, 2018.

Results: Primary spine care was associated with reduced total expenditures compared with usual care for SRDs. At site I, average per-patient expenditure was $162 in year 1 and $186 in year 2, compared with site II ($332 in year 1; $306 in year 2) and site III ($467 in year 1; $323 in year 2).

Conclusion: Among patients with SRDs included in this study, implementation of the PSC model within a conventional primary care setting was associated with a trend toward reduced total expenditures for spine care compared with usual primary care. Implementation of PSC may lead to reduced costs and resource utilization, but may be no more effective than usual care regarding clinical outcomes.

Keywords: Back Pain; Chiropractic; Low Back Pain; Neck Pain; Primary Health Care.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Ambulatory Care Facilities / economics
  • Chiropractic / economics
  • Cohort Studies
  • Family Practice / economics*
  • Female
  • Health Care Costs / statistics & numerical data*
  • Humans
  • Low Back Pain / economics*
  • Low Back Pain / therapy
  • Male
  • Middle Aged
  • Primary Health Care / economics*
  • Referral and Consultation / economics
  • Retrospective Studies