The recently published 2010 Complementary and Alternative Medicine Survey of Hospitals, sponsored by Samueli Institute and Health Forum, found a steady growth in the number of hospitals offering CAM services and therapies. A national survey conducted by the Veterans Administration is now showing this trend to be consistent at VA medical centers. Just as the VA has been a leader in patient safety and electronic health records, the VA, we believe, can provide lessons on CAM services that would be valuable to community hospitals.


The VA's interest in understanding the use and types of CAM practices in its system began in 1998 when it published a report based on site visits to 10 VA facilities and a survey of VA providers at all 22 integrated service networks. The report found that every selected VA site reported some use of CAM therapies. The report also found that veterans with chronic conditions were not responding well to conventional treatments, while a large proportion of veterans were using CAM to manage their conditions.

As a result, the VA commissioned its Healthcare Analysis and Information Group in 2002 to collect information on CAM practices throughout the entire system. This survey indicated that 84 percent of VA facilities either offered or referred patients to CAM modalities. Over the last decade, there has been growing evidence that the use of CAM by veterans was on the rise and that medical centers were continuing to offer more of these therapies.

In light of these developments, the VA Field Advisory Committee on CAM requested a follow-up survey in 2011. The new report found that 89 percent of facilities offered CAM while another 2 percent were planning to do so. The top reasons for offering CAM were to promote wellness, respond to patient preferences and provide an adjunct to chronic care. Meditation was the most common modality offered on-site, while acupuncture was the most frequently referred modality.

Of the many findings in this new report, there are two subjects that we believe would be of the most interest to community hospitals: the use of mind-body interventions and the mainstreaming of chiropractic care.

Use of Mind-Body Interventions

The veteran population suffers from a high number of trauma-related conditions (physical and emotional), and many veterans have chronic conditions for which conventional medicine has little to offer. The most common conditions being treated in the VA system are anxiety disorders, post-traumatic stress disorder, depression and back pain. Interestingly, the top modalities being used to treat these conditions are stress management and relaxation therapy, mindfulness, guided imagery, progressive muscle relaxation, and biofeedback — all variations on mind-body interventions.

The VA medical community's recognition of the profound effects that mind-body interventions have on trauma-related conditions is encouraging. These low-cost, high-impact modalities easily can be incorporated into the community hospital setting for patients suffering from trauma —anything from experiencing a violent crime to the diagnosis of a life-threatening illness. Hospitals could incorporate these modalities seamlessly in a variety of ways, such as training nursing staff to deliver simple meditation and guided imagery techniques; providing yoga or tai chi classes; or making available media-based interventions such as CDs, DVDs and computer-based interactive programs.

Another application that could have an impact on a hospital's bottom line is to offer mind-body interventions to health care providers. Burnout and compassion fatigue have been widely recognized as a financial burden for hospitals, which invest substantially in training and retention efforts.

Mainstreaming of Chiropractic Care

According to the 2011 survey report, a major development for the VA since 2002 is that chiropractic care is no longer considered a CAM modality and has been reclassified as mainstream practice. At 45 VA facilities nationwide, doctors of chiropractic are an integral part of the health care team and document their work on the patient's electronic health care record, says Anthony Lisi, D.C., national director of the VA Chiropractic Service. The inclusion of chiropractic care within the VA started in 2004 as a result of a congressional mandate that promised to deliver continuity of benefits to military personnel entering the VA system.

In 1995, the Department of Defense launched a three-year demonstration program that showed the inclusion of chiropractic services in 10 different sites was feasible and beneficial to participants. Data from the program also showed that traditional medical providers who were exposed to chiropractic colleagues working on-site judged as appropriate the use of spinal manipulation to treat conditions that did not involve neurological findings. Such medical providers increased their acceptance of spinal manipulation as a technique to treat those conditions over time.

In testimony in October 2000 before the House Committee on Veterans' Affairs, then Rear Admiral Michael Cowan stated that as a result of chiropractic care, there appeared to be a reduction in the number of physical therapy visits among patients with low back pain. The demonstration program also showed that chiropractic care may be associated with a reduction in the rate of back-related inpatient admissions among patients with at least one chiropractic visit.

According to the 2010 Complementary and Alternative Medicine Survey of Hospitals, 16 percent of responding hospitals already offered chiropractic care on an outpatient basis. Chiropractic care can be incorporated successfully within conventional care as an integral part of the care team.

Community hospitals may want to investigate the Department of Defense and VA's recent experience with CAM modalities. Lessons can be learned from the results of their mind-body interventions and from their integration of chiropractic care into the conventional care of veteran patients.

Sita Ananth, M.H.A., is the director of knowledge services at the Samueli Institute in Alexandria, Va. She is also a regular contributor to H&HN Daily. Leila Kozak, Ph.D., is an associate health fellow evaluating complementary and integrative medicine at the Northwest Center of Excellence for Outcomes Research in Older Adults at the VA Puget Sound Health Care System in Seattle.