A recent survey of 29 prominent integrative medical centers revealed that more than half deliver integrative care to patients in the hospitals with which they are affiliated. Using strategies that help lessen anxiety, reduce pain levels and increase patient engagement isn't just good for patients; with the advent of value-based reimbursement, in which payments to hospitals are tied to patient satisfaction, these strategies also might improve bottom lines.
The 2012 report Integrative Medicine in America: How Integrative Medicine Is Being Practiced in Clinical Centers Across the United States was commissioned by the Bravewell Collaborative to determine how and to what extent integrative care was being practiced. The study revealed a variety of models delivering integrative interventions to inpatients.
The Penny George Institute for Health and Healing began providing integrative services — basic stress-reduction strategies such as guided imagery, aromatherapy, acupressure, biofeedback and massage — to patients at Alliona Health's Abbott Northwestern Hospital in Minneapolis in 2003. To date, integrative interventions (including acupuncture) at Abbott Northwestern have been provided to more than 25,000 patients and have proven so successful in reducing pain, anxiety and nausea that Allina Health recently elevated integrative medicine to a clinical service line (like cardiology, oncology and neuroscience) and is beginning to institute the inpatient program at 10 other Allina hospitals.
In an Allina study published in the Journal of Patient Safety, the average reduction in pain scores was 1.9 points, the average pain reduction was approximately 55 percent and roughly 33 percent reported complete pain relief.
Allina helps make the program cost-effective through its Transformative Nursing Training Program. This program teaches nurses, who are already being paid, to deliver many of the integrative interventions at the bedside. "The more people on the front lines who have the tools, the more we can utilize these strategies," said Courtney Baechler, M.D., vice president of the Penny George Institute. Through a triage program, patients also have access to acupuncture, Chinese medicine and other integrative interventions that require a licensed practitioner. The cost of these more specialized services is absorbed in hospital overhead or through philanthropy.
Baechler noted that in recent inpatient surveys, more than 70 percent of the institute's patients reported high satisfaction.
Beth Israel Medical Center
The department of integrative medicine at Beth Israel Medical Center in New York offers a variety of integrative interventions to lessen pain, anxiety and nausea, as well as to improve medical outcomes, decrease medication use and accelerate healing. The inpatient program began in 2007 with such modalities as Reiki, acupuncture, yoga and stress management, including biofeedback, guided imagery, aromatherapy and meditation. Patients choose to enter the program or are referred by the physicians and residents. These services generally are funded by private grants; when the service is not available for free, patients can pay for it out of pocket.
Acupuncture, which is delivered by licensed acupuncturists through the acupuncture fellowship program, also is supported by private grants and provided without charge to patients.
Training grants increase the availability of integrative services. For instance, Beth Israel's Charles Evans Integrative Stress Management Program trains hospital nurses in Reiki, aromatherapy and guided imagery. The Urban Zen Yoga Program supports yoga trainees in providing integrative medical yoga stress-reduction to patients.
"The integrative approach emphasizes patient empowerment and encourages patients to take an active role in their health. Pain, anxiety and nausea, which we measure regularly before and after, are dropping by about two points on a 10-point scale," explains Roberta Lee, M.D., vice chair of the department of integrative medicine at Beth Israel Medical Center.
California Pacific Medical Center
The Institute for Health & Healing at California Pacific Medical Center in San Francisco, an affiliate of Sutter Health, provides integrative services to patients admitted to the medical center's four hospitals. These services include holistic nursing, massage, guided imagery, expressive arts, healing harp, medical clowns and spiritual care. Requests for the services, which are coordinated by a clinical nurse specialist, come from physicians, nurses, patients and family members.
The integrative practitioners are part of ongoing, interdepartment collaborative programs. In the oncology, pediatrics and palliative care departments, the integrative providers function as part of the medical team, participating in psychosocial rounds and providing patient services, educational events and employee care programs.
The program is fully supported by CMPC administrators and medical personnel. "We absolutely could not provide the level of symptom management we do without the institute's team," says Jennifer Cohen, M.D., chair of CMPC's pediatric pain committee.
Patient satisfaction scores are regularly 4.9 on a 5-point scale. "Pain and anxiety are reduced, but the most frequent comment we hear from patients is that these services provide a moment of comfort and care during a very challenging time. Patients tell us how grateful they are to CPMC for providing excellent medical care that includes this support for their whole being," said Judith Tolson, director of the institute.
While IHH employs dedicated staff, many integrative services are provided by interns who learn integrative strategies as part of a yearlong training program under the leadership of an IHH physician. The majority of the costs for integrative services are covered through philanthropy and proceeds from the institute's on-site store, which sells such things as books, tapes, art, vitamins and supplements. Tolson is working with the hospital administrators to identify other means of reimbursement as the requests for services they receive far outpace their ability to deliver them.
A Maryland Collaborative
The University of Maryland Center for Integrative Medicine in Baltimore is collaborating with the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center to provide integrative inpatient services — including Reiki, sound therapy, guided imagery, "art for compassion," therapeutic music, acupressure, yoga breathwork and meditation — to trauma patients. These services, which focus on reducing pain, are provided at the request of the patient or attending physician.
Provided by trained nurses and funded by the nursing budget, the integrative services are offered at no cost to patients, their family members and hospital staff.
The Center for Integrative Medicine, which was founded in 1991, launched the collaborative in August 2006 with one integrative nurse and a few part-time practitioners from the center. Now, the integrative care team, currently comprising four dedicated members, sees 20 to 30 patients a day — and the demand still far outweighs the team's capacity to fulfill all the requests. Throughout the hospital system a growing number of departments, including the perioperative unit, neurosurgery and the neonatal intensive care unit, are requesting integrative services.
"The success of this program has spurred the development of a prototype program that we envision will one day be offered throughout the University of Maryland Medical Center," says Brian Berman, M.D., founder and director of the university's Center for Integrative Medicine.
The Big Picture
An integrative approach treats the whole person, emphasizes patient empowerment and encourages patients to take an active role in their health. "I can think of no more important place to make integrative practices available than the inpatient environment, where serious medical crises happen every day," says Beth Israel's Lee.
Bonnie Horrigan is the executive director of the Bravewell Collaborative in Olivenhain, Calif.