Objective

Chiropractic trainees require exposure to a diverse patient base, including patients with multiple medical conditions. The Veterans Affairs (VA) Chiropractic Residency Program aims for its doctor of chiropractic (DC) residents to gain experience managing a range of multimorbid cases, yet to our knowledge there are no published data on the comorbidity characteristics of patients seen by VA DC residents. We tested 2 approaches to obtaining Charlson Comorbidity Index (CCI) scores and compared CCI scores of resident patients with those of staff DCs at 1 VA medical center.

Methods

Two processes of data collection to calculate CCI scores were developed. Time differences and agreement between methods were assessed. Comparison of CCI distribution between resident DC and staff DCs was done using 100 Monte Carlo simulation iterations of Fisher's exact test.

Results

Both methods were able to calculate CCI scores (n = 22). The automated method was faster than the manual (13 vs 78 seconds per patient). CCI scores agreement between methods was good (κ = 0.67). We failed to find a significant difference in the distribution of resident DC and staff DC patients (mean p = .377; 95% CI, .375–.379).

Conclusion

CCI scores of a VA chiropractic resident's patients are measurable with both manual and automated methods, although automated may be preferred for its time efficiency. At the facility studied, the resident and staff DCs did not see patients with significantly different distributions of CCI scores. Applying CCI may give better insight into the characteristics of DC trainee patient populations.

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Author notes

Vivian T. Ly is a postdoctoral fellow in the Chiropractic Section, VA Connecticut Healthcare System and Yale Center for Medical Informatics, Yale School of Medicine (300 George Street, Suite 501, New Haven, CT 06520; Vivian.ly@va.gov). Brian C. Coleman is an associate research scientist at the Yale Center for Medical Informatics, Yale School of Medicine, Yale University and the Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System (300 George Street, Suite 501, New Haven, CT 06520; Brian.Coleman@yale.edu). Christopher M. Coulis is a staff chiropractor in the Chiropractic Section of the VA Connecticut Healthcare System (950 Campbell Avenue, West Haven, CT 06516; Christopher.coulis@va.gov). Anthony J. Lisi is Chief of the Chiropractic Section at the VA Connecticut Healthcare System, and associate research scientist at the Yale Center for Medical Informatics, Yale School of Medicine, and Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System (950 Campbell Avenue, West Haven, CT 06516; Anthony.lisi@va.gov). Address correspondence to Vivian Ly, VA Connecticut Healthcare System and Yale Center for Medical Informatics, Yale School of Medicine, 300 George St. Suite 501, New Haven, CT 06520; Vivian.ly@va.gov. This article was received January 6, 2020, revised January 17, 2020, June 4, 2020, and June 18, 2020, and accepted July 27, 2020.

Concept development: VTL, BCC, CMC, AJL. Design: VTL, BCC, AJL. Supervision: AJL. Data collection/processing: VTL, BCC. Analysis/interpretation: VTL, BCC, AJL. Literature search: VTL. Writing: VTL, BCC, AJL. Critical review: VTL, BCC, CMC, AJL.