Musculoskeletal healthcare at a Swiss university hospital chiropractic medicine outpatient clinic in 2019: a health services research study

Abstract

Background The Balgrist University Hospital in Zurich, Switzerland, is an academic hospital focused on musculoskeletal (MSK) disorders. An integrated chiropractic medicine clinic provides chiropractic care to a broad patient population. Our health services research study aims to advance understanding of chiropractic health care service for quality assurance and health care quality improvement. Methods An observational clinical cohort study at the Balgrist chiropractic medicine clinic in 2019 was performed. The records of all patients with initial visits or returning initial visits (> 3 months since last visit) and their subsequent visits from January 1, 2019 to December 31, 2019, were used to create the study dataset. Data collected included demographic characteristics, diagnoses, imaging data, conservative treatments, surgeries, and other clinical care data. Descriptive statistics were used to summarize data. Results 1844 distinct patients (52% female, mean age 48 ± 17 years) were eligible and included in the study. 1742 patients had a single initial visit, 101 had 2 initial visits, and 1 patient had 3 initial visits during the study period. The most common main diagnoses were: low back pain (41%; 95% CI, 39–43%), neck pain (21%; 19–23%), and thoracic pain (8%; 7–9%). 29% had an acute (< 4 weeks) symptom duration, 10% subacute (4 to 12 weeks), and 52% chronic (> 12 weeks). Patients had a median number of 5 chiropractic visits during their episode of care, with a median care episode duration of 28 days. Only 49% (95% CI, 47–52%) of patient records had a clinical outcome that was extractable from routine clinical practice documentation retrievable from the hospital system. Conclusion Our health services research study provides an initial understanding of the patient characteristics and MSK clinical care delivered in a Swiss outpatient hospital setting and areas for clinical data quality assurance. Deeper insights into health care services and outcomes will help to facilitate a health quality improvement initiative by identifying clinical data and health care quality gaps, and establishing overall aims and targets for improvement.