Matthew A. Davis - US grants

Immediate and long-term career goals. The candidate's ultimate long-term career goal is to become an independent health services researcher specializing in complementary and alternative medicine (CAM). The candidate's immediate career goals during the award period include the acquisition of: (1) advanced skills required to manage and manipulate national healthcare datasets, (2) additional education and training in quantitative research, (3) a foundation in marketing research theory, and (4) the skills necessary to study patient decision-making processes. Achievement of the immediate career goals will be facilitated by the following activities: (1) didactic coursework at The Dartmouth Institute for Health Policy and Clinical Practice (TDI) and the Tuck School of Business at Dartmouth College, (2) mentored secondary data analyses, and (3) mentored development of grant-writing and manuscript preparation skills. Research project The candidate's research project will entail secondary data analyses using the Medical Expenditure Panel Survey (MEPS). The MEPS is conducted annually by The Agency for Health Research and Policy and is one of the largest sources of data on health services utilization and expenditures that includes services provided by CAM practitioners. The research project is a rigorous market share analysis of US practitioner-based CAM services that will examine longitudinal trends in CAM utilization and expenditures. The Specific Aims of the research project are to: (1) Determine how the market share of practitioner-based CAM services by US adults as a proportion of the national expenditures on all health services has changed between 2001-2007, and whether those changes were attributable to changes in patient volumes, unit costs, patient sociodemographics, and/or patient health status; (2) Perform a state-level supply and demand analysis of chiropractic services for California, New York, Texas, Florida, Illinois, Pennsylvania, and Ohio for 2001-2007 to determine whether there are geographic variations in CAM services utilization that are NOT explained by differences in patient sociodemographics, patient health status, or unit costs, but are correlated with the regional supply of chiropractors; and (3) Examine trends from 2007-2011 to determine whether CAM utilization changed at a different rate than did medical services utilization during the 2008-2009 economic downturn.

? DESCRIPTION (provided by applicant): Back pain is among the top contributors to disability among Americans and is associated with considerable cost to the US economy. Despite established practice guidelines that recommend conservative approaches, clinical management of nonspecific back pain (i.e., back pain that is not caused by pathologic etiology) varies, with evidence of overuse of opioid analgesics, early diagnostic imaging, and specialty care. Older adults in particular receive poorer care for nonspecific back pain than their younger counterparts. While nonspecific back pain is one of the top reasons adults visit physicians, it also happens to be one of the most common conditions treated by complementary and alternative medicine (CAM) providers who rely on conservative management. In the US, the chiropractic profession is the largest and most organized CAM group, and chiropractic care is the only CAM service covered by Medicare. However, current information available to health policymakers lacks a fundamental understanding of the potential indirect effects of chiropractic care in Medicare. The overall objective of this project is to rigorously examine the relationship between availability of chiropractic care and utilization, expenditures, and care for nonspecific back pain. Our central hypothesis is that chiropractic care is being used as a substitute for ambulatory medical services and affects both expenditures and nonspecific back pain care. This research project has the following two aims: (1) Among older adults, determine the extent to which availability of chiropractic care influences use of and expenditures on ambulatory medical services (e.g., primary care, specialty care, and emergency room visits) for nonspecific back pain and (2) Among older adults, determine the extent to which availability of chiropractic care influences clinical management of nonspecific back pain. Our approach is innovative because it departs from the current status quo by performing a real-world, natural experiment using Medicare patients who relocated. As each patient serves as his or her own control, this rigorous study design is better suited to identify causal relationships and will allow us the unique opportunity to observe the effect of a change in chiropractic care availability. In order to measure availability of chiropractic care and other health services, we will apply novel geographic information system (GIS) tools. This proposed project is significant because it will provide timely information for health policymakers to anticipate effects of healthcare system redesign; specifically, how inclusion of a CAM service in a national health insurance system impacts care of older adults with nonspecific back pain.

Project Abstract (Research Resources Core) The Research Resources Core (RRC) will support the overarching objective of the CAPRA to accelerate and expand multidisciplinary population-based AD/ADRD research by the development of robust research resources. This core will be dedicated to advancing large population-based research using a variety of rich secondary data sources in order to uncover and shed light on the complex and intertwined social, economic, and health systems effects of AD/ADRD. However, undertaking such analyses requires that researchers understand and surmount specific challenges, including: identifying relevant cohorts of older adults with demonstrated cognitive decline and/or dementia; monitoring short-term and long-term outcomes; and appreciating the local care-delivery environment. Through this core, we will package, create, and facilitate access to databases that help researchers identify relevant cohorts, outcomes of interest, and community factors?to help lower the barriers to their entry to the AD/ADRD research community. Data sources for AD/ADRD research that will be leveraged include Medicare administrative and assessment data, the Health and Retirement Study, the Michigan Long-term Services & Supports Data Archive and relevant publicly available population-based national health surveys. Research-identifiable Medicare and assessment data is both expensive to acquire and requires considerable analyst training; therefore, research with such data are often out-of-reach for researchers. However, simply facilitating access for researchers to Medicare and other large, complex health and healthcare datasets is not sufficient to ensure researchers can conduct rigorous and impactful research, particularly among early stage researchers or those new to AD/ADRD research. In this core, we will lower barriers and make high-quality data functionally accessible to AD/ADRD researchers by providing training products, aggregate data, and algorithms relevant to the field. In doing so, the RRC will also develop and disseminate a series of innovative research training activities, including the Current Topics in Dementia and Alzheimer?s Disease Research podcast & blog (the ?CAPRAcast?) and a webinar series devoted to training AD/ADRD researchers (the ?CAPRAclass?). We will leverage the expansive, multidisciplinary AD/ADRD research expertise at the University of Michigan and partnered external collaborators to develop resources necessary to support a wide array of AD/ADRD research. The RRC will support and foster multidisciplinary, population-based AD/ADRD research by the development of rigorous AD/ADRD-specific training, the creation and dissemination of research tools, and the provision of access to high-quality data. In this way the core will work synergistically with the other CAPRA cores by providing robust AD/ADRD research resources and training that support the overarching center aims.