{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T10:06:25Z","timestamp":1790762785063,"version":"4.1.0"},"reference-count":45,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Office of Patient-Centered Care and Cultural Transformation and Quality Enhancement Research Initiative","award":["PEC 16-354"],"award-info":[{"award-number":["PEC 16-354"]}],"id":[{"id":"https:\/\/ror.org\/03cdz5d08","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Acupunct Med"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Some complementary and integrative health (CIH) therapies are recommended for the management of chronic musculoskeletal pain, but little research has evaluated how these alternatives affect downstream healthcare utilization, including imaging costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Using US Department of Veterans Affairs (VA) Veterans Health Administration electronic health record data, we conducted propensity score modeling, allocating 2,215,231 Veterans with chronic pain using the VA from 2018 to 2022 into two therapy exposure groups \u2013 acupuncture with and without movement therapies (yoga or Tai Chi\/Qigong) \u2013 compared with conventional care, or primary care management alone, to examine differences in imaging costs during a 6-month period following indexing. We calculated the probability of treatment in either exposure group based on demographic and clinical characteristics, and applied a nearest neighbor matching algorithm for subsequent estimation of average treatment effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Veterans using acupuncture with or without movement therapies had sizable baseline clinical needs and healthcare utilization. After matching, we found that imaging costs and visits were higher among Veterans using acupuncture with CIH movement therapies (cost difference $140, 95% confidence interval (CI) $97\u2013$183; visit difference 0.37; 95% CI 0.30\u20130.45) and without CIH movement therapies (cost difference $155, 95% CI $147\u2013$163; visit difference 0.34; 95% CI 0.33\u20130.35) during the 6-month follow-up period, compared with those using conventional care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Veterans using acupuncture with or without CIH movement therapies had greater imaging costs than those using conventional care, possibly reflecting higher usage of healthcare among integrative therapy patients. These results also suggest unobserved patterns of comorbidity, recovery or access and\/or radiology inefficiencies leading to an imaging loop effect as potential considerations for future investigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09645284261453946","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T11:29:28Z","timestamp":1783596568000},"page":"263-279","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of acupuncture, movement therapies and imaging costs among Veterans with chronic musculoskeletal pain"],"prefix":"10.1177","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6613-2506","authenticated-orcid":false,"given":"Stephen","family":"Frochen","sequence":"first","affiliation":[{"name":"VA Center for the Study of Health Care Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, West Los Angeles VA Medical Center, Los Angeles, CA, USA"},{"name":"VA Veterans Emergency Management Evaluation Center, VA Greater Los Angeles Healthcare System, Sepulveda VA Medical Center, North Hills, CA, USA"},{"name":"VA Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda VA Medical Center, North Hills, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie L.","family":"Taylor","sequence":"additional","affiliation":[{"name":"VA Center for the Study of Health Care Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, West Los Angeles VA Medical Center, Los Angeles, CA, USA"},{"name":"University of California Los Angeles, Department of Medicine and Department of Health Policy and Management, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Coggeshall","sequence":"additional","affiliation":[{"name":"VA Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Chen","sequence":"additional","affiliation":[{"name":"VA Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA"},{"name":"VA Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Denver, CO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven B.","family":"Zeliadt","sequence":"additional","affiliation":[{"name":"VA Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA"},{"name":"University of Washington, Department of Health Systems and Population Health, School of Public Health, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"crossref","unstructured":"Gaskin DJ Richard P. 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