As greater numbers of Americans seek to improve their health and augment traditional health care with complementary and alternative therapies, it becomes increasingly critical to build channels of communication and collaboration among all the practitioners who provide this care.
Clinicians need to employ care coordination, in which all providers who work with a particular patient share important clinical information and have clear, shared expectations about their roles. Including both allopathic and complementary and alternative medicine clinicians in care coordination is essential.
Failures in Coordination, Past and Present
About a decade ago, health care leaders came up with "integrative health care," which they meant to describe how providers would work together. But the term meant different things to different people and described many ways of working together.
In a 2004 paper published in BMC Health Services Research, Heather Boon of the University of Toronto and colleagues describe a continuum of models that range from parallel (in which independent practitioners are simply working in the same setting) to integrative (an interdisciplinary, nonhierarchical blending of conventional medicine and complementary therapies) with the latter being the most synergistic. Along the continuum, they found that reliance on the biomedical scientific model decreases with greater integration, that dependence on hierarchy and defined roles decreases, that practitioner autonomy increases, and that importance of consensus increases.
In the United States today, fragmented systems and communication breakdowns contribute to widespread failures in care coordination. Studies have shown that a patient with multiple chronic conditions can have up to five specialists or health care professionals taking care of his or her needs. Add to this the fact that one in four Americans is seeking alternative therapies, which are most often self-referred and outside of the "system."
Today, almost 25 percent of hospitals in the United States are offering massage therapy, acupuncture and other non-allopathic therapies. While conducting a biannual survey of CAM in U.S. hospitals and interviewing hospital administrators about creating a culture that supported integrative health, I learned there are several key facets: having physician and nursing champions; educating administrators and potential naysayers and allowing them to experience some modalities; creating a culture of self-care among leaders and employees; and choosing CAM practitioners based on organizational values and culture.
A Study of Collaborative Care
While the models hospitals employ vary, more lessons are emerging in the delivery of interprofessional, collaborative patient care. Tara DeMarco, a wellness consultant and doctoral candidate at the California Institute of Integral Studies, conducted a study of three well-established, hospital-based programs in the United States.
Over a period of six months, DeMarco gathered data through interviews, records, observation and reports from the Center for Health and Healing at Beth Israel Medical Center in New York City; the Integrative Medicine Center at Yale-affiliated Griffin Hospital in Derby, Conn.; and North Hawaii Community Hospital in Kamuela. She identified key challenges and value factors to team-based integrative care along with emerging best practices and facilitators. Some of these findings are below.
In addition to the typical lack of communication and operational complexity found in traditional allopathic medical settings, she identified the following challenges:
- competition, territorialism and turf issues that impede collaboration
- operational complexity in trying to standardize systems across varied modalities and disciplines
- physician resistance (a common theme I found even in my CAM hospital surveys from 2003 to 2010)
- barriers to evidence-based medicine (getting acceptance and recognition for new standards of validated research)
She also discovered the value created for providers and patients in establishing a collaborative, integrative approach:
- a multidisciplinary team that creates a venue for in-house teaching and learning
- one-stop shop for patients who can access all their needs under one roof
- an expanded clinical toolbox that allows providers and patients to avail themselves of the best that all therapies and modalities have to offer
- forging a new language that bridges the communication gaps between providers
- integrative providers who often serve as the lifeline for patients who have exhausted all conventional options
In addition, DeMarco uncovered some emerging success factors and best practices in team-based care that are contributing to the success of these centers:
- establishing formal communication channels, including case conferences, healing circles and staff retreats
- building a physical space that creates a healing environment and facilitates teamwork
- engaging staff who are open minded, yet demand scientific rigor
- encouraging internal cross-referrals and cross-disciplinary education for providers
As health reform pushes hospitals to test new structures, there is an opportunity to design more proactive patient-centered care models. More cohesive care coordination includes a whole-person approach that incorporates the best that both allopathic and complementary therapies have to offer.
Sita Ananth, M.H.A., is a Napa, Calif.–based writer specializing in complementary and alternative medicine. She is also a regular contributor to H&HN Daily.