Factors Associated With Posttraumatic Stress Disorder Among Veterans of Recent Wars Receiving Veterans Affairs Chiropractic Care

Coleman, Brian; Corcoran, Kelsey; DeRycke, Eric; Bastian, Lori A.; Brandt, Cynthia; Haskell, Sally G.; Heapy, Alicia; Lisi, Anthony J.

doi:10.1016/j.jmpt.2019.10.016

Cited by 8 publications

(5 citation statements)

References 37 publications

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“…Veterans with musculoskeletal pain conditions, especially those of chronic nature, often utilize non-pharmacological pain management recommended by clinical practice guidelines, including U.S. Department of Veterans Affairs (VA) chiropractic care [10][11][12][13]. Many veterans with musculoskeletal pain conditions, including those receiving chiropractic care, demonstrate high prevalence of comorbid medical and mental health conditions [14][15][16], with those having higher comorbidity burdens demonstrating greater healthcare utilization [17].…”

Section: Rationalementioning

confidence: 99%

Exploring supervised machine learning approaches to predicting Veterans Health Administration chiropractic service utilization

et al. 2020

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Background: Chronic spinal pain conditions affect millions of US adults and carry a high healthcare cost burden, both direct and indirect. Conservative interventions for spinal pain conditions, including chiropractic care, have been associated with lower healthcare costs and improvements in pain status in different clinical populations, including veterans. Little is currently known about predicting healthcare service utilization in the domain of conservative interventions for spinal pain conditions, including the frequency of use of chiropractic services. The purpose of this retrospective cohort study was to explore the use of supervised machine learning approaches to predicting one-year chiropractic service utilization by veterans receiving VA chiropractic care. Methods: We included 19,946 veterans who entered the Musculoskeletal Diagnosis Cohort between October 1, 2003 and September 30, 2013 and utilized VA chiropractic services within one year of cohort entry. The primary outcome was one-year chiropractic service utilization following index chiropractic visit, split into quartiles represented by the following classes: 1 visit, 2 to 3 visits, 4 to 6 visits, and 7 or greater visits. We compared the performance of four multiclass classification algorithms (gradient boosted classifier, stochastic gradient descent classifier, support vector classifier, and artificial neural network) in predicting visit quartile using 158 sociodemographic and clinical features. Results: The selected algorithms demonstrated poor prediction capabilities. Subset accuracy was 42.1% for the gradient boosted classifier, 38.6% for the stochastic gradient descent classifier, 41.4% for the support vector classifier, and 40.3% for the artificial neural network. The micro-averaged area under the precision-recall curve for each oneversus-rest classifier was 0.43 for the gradient boosted classifier, 0.38 for the stochastic gradient descent classifier, 0.43 for the support vector classifier, and 0.42 for the artificial neural network. Performance of each model yielded only a small positive shift in prediction probability (approximately 15%) compared to naïve classification.

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Section: Rationalementioning

confidence: 99%

Exploring supervised machine learning approaches to predicting Veterans Health Administration chiropractic service utilization

et al. 2020

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Section: Discussionmentioning

confidence: 99%

“…Of interest was Mental Health among the classes mentioned least frequently, given comorbid pain and mental health conditions are common in the OEF/OIF/OND Veteran population 27 28 and those receiving VHA chiropractic care. 29 Further, recognition of the contributions of psychosocial factors, and mental health conditions as an extension of those factors, to a patient's pain experience is an expected best practice of chiropractic care consistent with a biopsychosocial model of care. 26 We suspect this finding is due to chiropractors not considering or not documenting mental health conditions or psychosocial factors related to mental health, given the vocabulary was viewed as appropriate by the study team.…”

Section: Discussionmentioning

confidence: 99%

Extracting Pain Care Quality Indicators from U.S. Veterans Health Administration Chiropractic Care Using Natural Language Processing

et al. 2023

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Background Musculoskeletal pain is common in the Veterans Health Administration (VHA), and there is growing national use of chiropractic services within the VHA. Rapid expansion requires scalable and autonomous solutions, such as natural language processing (NLP), to monitor care quality. Previous work has defined indicators of pain care quality that represent essential elements of guideline-concordant, comprehensive pain assessment, treatment planning, and reassessment. Objective Our purpose was to identify pain care quality indicators and assess patterns across different clinic visit types using NLP on VHA chiropractic clinic documentation. Methods Notes from ambulatory or in-hospital chiropractic care visits from October 1, 2018 to September 30, 2019 for patients in the Women Veterans Cohort Study were included in the corpus, with visits identified as consultation visits and/or evaluation and management (E&M) visits. Descriptive statistics of pain care quality indicator classes were calculated and compared across visit types. Results There were 11,752 patients who received any chiropractic care during FY2019, with 63,812 notes included in the corpus. Consultation notes had more than twice the total number of annotations per note (87.9) as follow-up visit notes (34.7). The mean number of total classes documented per note across the entire corpus was 9.4 (SD=1.5). More total indicator classes were documented during consultation visits with (mean=14.8, SD=0.9) or without E&M (mean=13.9, SD=1.2) compared to follow-up visits with (mean=9.1, SD=1.4) or without E&M (mean=8.6, SD=1.5). Co-occurrence of pain care quality indicators describing pain assessment was high. Conclusion VHA chiropractors frequently document pain care quality indicators, identifiable using NLP, with variability across different visit types.

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“…10,11 It is suspected that portal-of-entry providers-such as chiropractors-may encounter a high rate of patients with risk factors associated with suicide including chronic pain, depression, anxiety, posttraumatic stress disorder, substance use disorder (not performance enhancing drugs), a sense of hopelessness, or a sense of helplessness. [12][13][14][15][16] First Published Online January 21 2022 It is currently unknown how often chiropractors encounter patients at risk of suicide in the US or anywhere else worldwide. Several factors highlight the growing importance for chiropractors to be trained in recognizing the suicidal patient: (1) chiropractors are portal-of-entry providers, 9 (2) growing workforce of chiropractors at the Veterans Health Administration, 17 (3) expansion of integrated clinical residency opportunities within the Veterans Health Administration, 18 (4) high prevalence of psychiatric comorbidities presenting with spinal complaints, 16,19 (5) opioid crisis generating demand for nonpharmacological health care services, 20 and (6) an elevated risk of suicidal ideation in patients with psychiatric comorbidities prescribed antiepileptics for spinal pain.…”

Section: Objectivementioning

confidence: 99%

“…[12][13][14][15][16] First Published Online January 21 2022 It is currently unknown how often chiropractors encounter patients at risk of suicide in the US or anywhere else worldwide. Several factors highlight the growing importance for chiropractors to be trained in recognizing the suicidal patient: (1) chiropractors are portal-of-entry providers, 9 (2) growing workforce of chiropractors at the Veterans Health Administration, 17 (3) expansion of integrated clinical residency opportunities within the Veterans Health Administration, 18 (4) high prevalence of psychiatric comorbidities presenting with spinal complaints, 16,19 (5) opioid crisis generating demand for nonpharmacological health care services, 20 and (6) an elevated risk of suicidal ideation in patients with psychiatric comorbidities prescribed antiepileptics for spinal pain. 21,22 In the US, the chiropractic profession has multiple opportunities available for suicide prevention education including doctor of chiropractic programs (DCPs), doctor of chiropractic residency programs (DCRPs), postgraduate continuing education (CE), and diplomate training programs (DTPs) under the American Board of Chiropractic Specialty programs (ABCS).…”

Section: Objectivementioning

confidence: 99%

The prevalence of suicide prevention training and suicide-related terminology in United States chiropractic training and licensing requirements

Cupler¹,

Price²,

Daniels³

2022

Journal of Chiropractic Education

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Objective To summarize the prevalence of suicide-related terminology in US doctor of chiropractic educational programs, residency programs, continuing education training, diplomate training programs, and state licensure requirements. The secondary objective was to provide next-step recommendations to enhance suicide prevention education and training for the profession. Methods A review of public-facing electronic documents and websites occurred from April to May 2020 for doctor of chiropractic program course catalogs, residency program curriculum overviews, state licensing requirements, candidate handbooks for the chiropractic specialties, and continuing education training. Data were extracted to tables reflecting the state of suicide prevention training and suicide-related terminology. Descriptive statistics were used to report the findings. Results Of 19 doctor of chiropractic programs, 54 relevant courses were identified. No course catalogs specifically mentioned suicide prevention education, but specific risk factor-related terminology was highlighted. For the 10 doctor of chiropractic residency programs, all required mandatory trainee training, which included suicide prevention education. Two states required suicide prevention education training as part of the state re-licensure process and are available through 4 continuing education courses. No diplomate training program handbooks included a requirement of suicide prevention education though suicide risk-factor terminology was described in some handbooks. Conclusion The state of suicide prevention training in the chiropractic profession documented in handbooks is largely lacking and widely varied at this time. The development of profession-specific suicide prevention continuing education may be beneficial for practicing chiropractors, and suicide prevention curriculum development at the doctor of chiropractic programs may prepare future doctors of chiropractic.

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Factors Associated With Posttraumatic Stress Disorder Among Veterans of Recent Wars Receiving Veterans Affairs Chiropractic Care

Cited by 8 publications

References 37 publications

Exploring supervised machine learning approaches to predicting Veterans Health Administration chiropractic service utilization

Exploring supervised machine learning approaches to predicting Veterans Health Administration chiropractic service utilization

Extracting Pain Care Quality Indicators from U.S. Veterans Health Administration Chiropractic Care Using Natural Language Processing

The prevalence of suicide prevention training and suicide-related terminology in United States chiropractic training and licensing requirements

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