John Weeks June 2013 Integrator Round-up covering the topics of integratve health care organizations.

Joint Commission to create expert panel to further develop non-pharmacological pain standards

The Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) has stimulated a new initiative of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to “further develop the Joint Commission’s standards” in the area of non-pharmacological pain standards. The JCAHO decision was made, according to this letter from CAHCIM chair Ben Kligler, MD, MPH, “in response to a petition from medical school faculty at 20 member institutions of the Consortium on the need for more integration of non-pharmacological treatments for pain into JCAHO’s standards.” Daniel Castillo, MD, medical director in the Division of Healthcare Quality Evaluation, has reportedly agreed to establish an expert panel to further develop the Joint Commission’s standards in this area.

Comment: Congratulations CAHCIM for initiating this exceptional piece of strategic, transformational work. This is prime evidence of the critical, go-between role in system change of the integrative medicine doctors, as described above by Tracy Gaudet, MD. Now, here’s hoping that CAHCIM and JCAHO will honor the spirit of interprofessional practice and team care in the field’s definition of integrative medicine by including at least one member of the licensed complementary and alternative medicine (CAM) disciplines on their team. The numbers of individuals who see chiropractors, acupuncturists, massage therapists and naturopathic doctors for pain conditions is in the tens of millions.


“Consensus” Core Competencies for Pain Management published; acupuncture the only non-conventional field invited into the room

An interprofessional consensus conference has led to the publication in Pain Medicine of Core Competencies for Pain Management: Results of an Interprofessional Consensus Summit. The process: “Through an interprofessional consensus process, core competencies in pain assessment and management were developed to address pre-licensure pain management education in all major health care professions.” Ten disciplines were included. The one integrative health field invited in was acupuncture, via two professionals: Ian Koebner, LAc, MAOM, with the UC David Health System, a member of the interprofessional author team; and a consensus conference participant, Steve Given, LAc, DAOM, with San Francisco’s American College of Traditional Chinese medicine.

The group published 25 total competencies in 5 domains. Some of the most relevant to integrative health are: “demonstrate the inclusion of patient and others, as appropriate, in the education and shared decision-making process for pain care; identify pain treatment options that can be accessed in a comprehensive pain management plan; describe the role, scope of practice, and contribution of the different professions within a pain management care team; and, implement an individualized pain management plan that integrates the perspectives of patients, their social support systems, and health care providers in the context of available resources.

Comment: Always interesting to see who is in and who is out of these “consensus” projects. If a profession is out, are their contributions therefore not among the “different professions” from which contributions to optimal pain treatment should be considered? No one from the integrative health community was on the 7-person executive committee. No chiropractors, massage therapists, naturopathic doctors or yoga therapists were involved. Nor were any well-known integrative medical doctors included at any stage of the operation. (Correct me if I am wrong.) Nor were any integrative health terms beyond “acupuncture/education” searched in the background research. “Integrative medicine” was not. Notably, while the executive team espoused a plan to include relevant pain organizations, the multidisciplinary American Academy of Pain Management, which espouses an integrative model, was not. The most egregious oversight, besides the willful exclusion of AAPM, was to not include chiropractors, certainly a major pain-related profession. That field has 250% the number of practitioners as acupuncture.

That stated, it is good to see this level of interprofessional activity occurring. The work brought to mind the 2009-2011 collaborative work of medicine’s Big 6 disciplines (pharmacy, medicine, nursing, public health, dentistry, osteopathy) to publish the Core Competencies for Interprofessional Collaborative Practice. The movement is from dictatorship (by MDs) to oligarchy (exclusive subsets of disciplines). Each is a step in the right direction, out of silos and into team. Still, it would be nice if they could actually operationalize what “patient-centered” means.


Samueli Institute shares a decade of research on healing and complementary and integrative approaches

On June 4, 2013, the Samueli Institute, led by Wayne Jonas, MD, announced that they have opened a publicly-accessible “searchable database on the science of healing.” The site includes the Institute’s studies on pain and stress management, and complementary and integrative approaches. The announcement stated that “visitors can access a decade of research that explores wellness and whole-person healing through evidence-based publications.” Access is here. Meantime, the Institute’s 2012 Annual Report notes that the organization added 15 employees that year, while “disseminating the results of our work and research through 84 journal articles, two books, eight book chapters, 148 presentations, and 18 scientific conferences and meetings.” Total revenues for 2012 were $13,145,000.

Comment: Fascinating body of work here. A colleague examined the publications and noted that only two, however, seem to hold a focus on the critically important economic dimensions of integrative health and medicine practices and disciplines. Jonas has been interested in the topics since he mounted a daylong workshop on related to coverage issues in 1996 when he ran the old Office of Alternative Medicine at the NIH and right up to publishing Patricia Herman, ND, PhD’s seminal volume. I was surprised at the low number. Be good to see more attention to cost outcomes in the Samueli work. Joel Grey’s character in Cabaret was right: Money makes the (healthcare) world go round.


New AHA study puts hospital CAM inclusion data point at 50% lower than 2010 survey

As part of the fiscal year 2011 data collected in 2012 by the American Hospital Association (AHA) Annual Survey, the AHA asked if the hospital offers complementary and alternative medical services. The finding: 902 of 4782 responding US hospitals (19%) indicated they offered CAM services. The percent is significantly below the 42% reported in a 2010 survey of hospitals sponsored by the AHA and the Samueli Institute. That survey focused only on CAM offerings.

Comment: I contacted the AHA’s communications staff and asked how they would explain the difference. Was it the sample? The staffer responded: “The AHA Annual Survey has a much higher response rate from hospitals than the CAM supplemental survey. For the CAM supplemental survey, the response rate was likely skewed to hospitals that already reported offering CAM services.”  She noted that the “expanded survey on CAM services” has been done about every 3 years but that at this point, there are no plans for another CAM survey due to cost. Meantime, the 19% is sobering for anyone who has trotted out the prior data.