Variations in the Implementation and Characteristics of Chiropractic Services in VA

By: Lisi JA, Khorsan R, Smith MM, Mittman BS
Publication Name: Medical Care
Year: 2014


In 2004, the US Department of Veterans Affairs expanded its delivery of chiropractic care by establishing onsite chiropractic clinics at select facilities across the country. Systematic information regarding the planning and implementation of these clinics and describing their features and performance is lacking.


To document the planning, implementation, key features and performance of VA chiropracticclinics, and to identify variations and their underlying causes and key consequences as well as their implications for policy, practice, and research on the introduction of new clinicalservices into integrated health care delivery systems.

Research Design, Methods, and Subjects:

Comparative case study of 7 clinics involving site visit–based and telephone-based interviews with 118 key stakeholders, including VA clinicians, clinical leaders and administrative staff, and selected external stakeholders, as well as reviews of key documents and administrative data on clinic performance and service delivery. Interviews were recorded, transcribed, and analyzed using a mixed inductive (exploratory) and deductive approach.

Results and Conclusions:

Interview data revealed considerable variations in clinic planning and implementationprocesses and clinic features, as well as perceptions of clinic performance and quality. Administrative data showed high variation in patterns of clinic patient care volume over time. A facility’s initial willingness to establish a chiropractic clinic, along with a higher degree of perceived evidence-based and collegial attributes of the facility chiropractor, emerged as key factors associated with higher and more consistent delivery of chiropractic services and higher perceived quality of those services.