The candidate has the objective of obtaining further education and training in order to realize his goal of a career in CAM research. The acquired skills will be applied to three specific aims on the utilization and safety of chiropractic in older U.S adults. The analysis of large national samples of Medicare claims data will take place in a unique research environment that is internationally known for utilizing such data in health policy research.
Specific Aim #1 will use a retrospective cohort design with descriptive analysis to examine geographic variations in chiropractic availability, utilization and cost for adults over 65. It is anticipated that these data will provide useful insights to inform health care policy decision making, as utilization studies from The Dartmouth Institute for Health Policy and Clinical Practice (TDI) have historically done in other fields. The other two aims will examine safety issues in older patients, using case-control designs. With growing utilization of chiropractic services by an expanding elderly population, safety issues are becoming increasingly important.
Specific Aim #2 will evaluate the incidence of stroke and certain stroke subtypes following chiropractic spinal manipulation among adults over 65. This study will ascertain the risk of stroke temporally associated with chiropractic treatment, and compare the results with the risk of stroke following visits to other types of providers.
Specific Aim #3 will evaluate the risk of selected injuries of the head, neck and trunk following chiropractic spinal manipulation in adults over 65, again compared to the risk following visits to other provider types. The analysis will also evaluate associations between injuries and pre-existing conditions that are considered contraindications to chiropractic spinal manipulation. At the end of this five-year project, which will include a rigorous formal training program at TDI as well as mentored research, the candidate's goal is to attain status as an independent research investigator, applying the skills obtained in the program to the evaluation of CAM therapies.

Public Health Relevance

A comprehensive understanding of resources and delivery of CAM care becomes increasingly important as the percentage of the population covered by Medicare increases. Additionally, it is essential to recognize the risk of complications in the elderly. The proposed studies address these pressing issues using established techniques and approaches pioneered at TDI.

National Institute of Health (NIH)
National Center for Complementary & Alternative Medicine (NCCAM)
Research Scientist Development Award - Research & Training (K01)
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Application #
Study Section
Special Emphasis Panel (ZAT1-LD (28))
Program Officer
Khalsa, Partap Singh
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Dartmouth College
Public Health & Prev Medicine
Schools of Medicine
United States
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Whedon, James M; Kimura, Melissa N; Phillips, Reed B (2016) Racial Disparities in Use of Chiropractic Services by Medicare Beneficiaries Aged 65 to 99 in Los Angeles County, California. J Evid Based Complementary Altern Med 21:131-7
Whedon, James M; Mackenzie, Todd A; Phillips, Reed B et al. (2015) Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66 to 99 years. Spine (Phila Pa 1976) 40:264-70
Whedon, James M; Song, Yunjie; Mackenzie, Todd A et al. (2015) Risk of stroke after chiropractic spinal manipulation in medicare B beneficiaries aged 66 to 99 years with neck pain. J Manipulative Physiol Ther 38:93-101
Smith, Monica; Davis, Matthew A; Stano, Miron et al. (2013) Aging baby boomers and the rising cost of chronic back pain: secular trend analysis of longitudinal Medical Expenditures Panel Survey data for years 2000 to 2007. J Manipulative Physiol Ther 36:2-11
Whedon, James M; Song, Yunjie (2012) Racial disparities in the use of chiropractic care under Medicare. Altern Ther Health Med 18:20-6
Whedon, James M; Song, Yunjie; Davis, Matthew A et al. (2012) Use of chiropractic spinal manipulation in older adults is strongly correlated with supply. Spine (Phila Pa 1976) 37:1771-7
Whedon, James M; Song, Yunjie (2012) Geographic variations in availability and use of chiropractic under medicare. J Manipulative Physiol Ther 35:101-9
Davis, Matthew A; Whedon, James M; Weeks, William B (2011) Complementary and alternative medicine practitioners and Accountable Care Organizations: the train is leaving the station. J Altern Complement Med 17:669-74
Whedon, James M; Davis, Matthew A (2010) Medicare part B claims for chiropractic spinal manipulation, 1998 to 2004. J Manipulative Physiol Ther 33:558-61
Whedon, James M; Fulton, Gwen; Herr, Charles H et al. (2009) Trauma patients without a trauma diagnosis: the data gap at a level one trauma center. J Trauma 67:822-8

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