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faction scores? Although approaches to control chiropracticcosts exist in managed care, it seems reasonable thatcompetitive-minded practices and networks will evolvethat use outcomes management as a direct quality improvementtool aimed at delivering the best and most costefficientproduct. And what just may evolve are spinal caresystems that effectively integrate chiropractic services withsurgical and nonsurgical medical systems (Triano and Raley,1994).OVER-EXTRAPOLATIONOF OUTCOMES DATAIt is important not to over-extrapolate outcomes, especiallyas it relates to cost-effectiveness. Specific issues as to patientand case mix must be considered. For example, a recentreview of health data demonstrates that a healthiersegment of the back pain population sought care from chiropractorscompared to those who sought care from medicalHCPs (Hurwitz and Morgenstern, 1997). Given good Chiropractic Austinoutcomes for chiropractic care, one must determine the respectivecontributions of patient load and intervention.The use of uncontrolled or nonadjusted outcomes data toposition one’s practice, “technique” system, or professionmore favorably through health policy or political avenueswill sound methodological alarms and likely not be convincing.OUTCOMES DATA Westlake ChiropracticAS A REGULATORY HAMMER?Using outcomes data for profiling HCPs has a minimal effecton utilization of clinical procedures (Balas et al, 1996).There is a need for controlled clinical evaluations on howutilization management approaches affect both HCP behaviorand care quality before subjecting large numbers ofHCPs to interventions aimed at reducing practice variation.Outcomes data, at least for now, seems likely to bebest used as a quality improvement tool, and in a moreglobal sense as a market incentive to deliver care thatmeets community need. In other words, as a carrot, outcomesmanagement appears promising. As a stick, it seems Chiropractic Austin
