Bonnie Horrigan is Director of Communications and Public Education at The Bravewell Collaborative, United States. Show
Find articles by Bonnie Horrigan Sheldon Lewis is an Editorial and Communications Consultant, United States. Find articles by Sheldon Lewis Donald Abrams, MD, is an integrative oncologist at the UCSF Osher Center for Integrative Medicine and Professor of Clinical Medicine at the University of California San Francisco, United States. Find articles by Donald I. Abrams Constance Pechura, PhD, is Senior Scientific Advisor at The Bravewell Collaborative, United States. Find articles by Constance Pechura The impetus for developing and implementing integrative medicine strategies is rooted in the desire to improve patient care. The Bravewell Collaborative, a philanthropic organization that works to improve healthcare, defines integrative medicine as “an approach to care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual, and environmental influences that affect a person's health. Employing a personalized strategy that considers the patient's unique conditions, needs, and circumstances, it uses the most appropriate interventions from an array of scientific disciplines to heal illness and disease and help people regain and maintain optimum health.” Over the past 2 decades, there has been documented growth in the number of clinical centers providing integrative medicine, the number of medical schools teaching integrative strategies, the number of researchers studying integrative interventions, and the number of patients seeking integrative care. But whether integrative medicine was being offered in the same, similar, or disparate ways was unknown. In addition, while previous studies focused on the prevalence and use of complementary or alternative medicine (CAM) by patients1,2 or by practitioners in hospital settings3 by enumerating the use of single CAM therapies, very little information had been collected regarding the actual practice of integrative medicine, which by definition treats the whole person. In 2011, The Bravewell Collaborative commissioned a survey to determine how integrative medicine was currently being practiced across the United States by (1) describing the patient populations and health conditions most commonly treated, (2) defining the core practices and models of care, (3) ascertaining how services are reimbursed, (4) identifying the values and principles underlying the care, and (5) determining the biggest factors driving successful implementation. Twenty-nine integrative medicine centers and programs across the nation were chosen to participate in the study. This group included the nine centers in The Bravewell Clinical Network plus 20 others that, directed by either a physician, other doctoral level healthcare practitioner, or nurse, were chosen on the basis of length of time in operation (a minimum of 3 years), patient volume, and/or prior clinical contributions to the field. MAJOR FINDINGS
The strong affiliations to hospitals, healthcare systems, and medical and nursing schools as well as the centers' collaborative work with and growing referrals from their own health systems reveal that integrative medicine is now an established part of healthcare in the United States. The fact that integrative medicine is being practiced in diverse sites across the country with high levels of concordance of interventions for specific conditions suggests that integrative medicine practice is informed by a common knowledge base. The data from the survey reveals that integrative medicine centers embrace a group of core values that inform and radiate through their practice and interactions with their patients. Integrative care is, in practice, patient-centered care and is a fundamentally collaborative enterprise fostering cooperation between patients and practitioners, and among the practitioners themselves. One of the most striking, though perhaps predictable, conclusions of this study is that integrative medicine is, in fact, integrative. It integrates conventional care with non-conventional or non-Western therapies; ancient healing wisdom with modern science; and the whole person—mind, body, and spirit in the context of community. Outcomes dataMost centers report that, because of limited human and financial resources, they are unable to analyze and disseminate the treatment and outcomes data they collect. Providing funding for analysis of these data, which could provide important information about the efficacy of integrative medicine approaches as well as the treatment of chronic health conditions, should be a priority for funding sources and institutions. Best PracticesThe field of integrative medicine is still being developed. Systems to identify and share best practices among integrative medicine centers and practitioners should be developed and implemented so that more patients have access to the benefits of integrative medicine approaches. Follow-up SurveyTo track the progress of integrative care, a follow-up survey in 3 to 5 years, building on the questionnaire employed in this report, should be conducted. Comparing the results reported here with those to be found in future studies may be helpful in identifying innovation and trends in the delivery, effectiveness, and use of integrative care. As integrative medicine developed and practitioners sought to define core practices, a common definition and philosophy of care emerged. The Bravewell Collaborative uses the following description in all of its work.4 Integrative medicine is an approach to care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual, and environmental influences that affect a person's health. Employing a personalized strategy that considers the patient's unique conditions, needs and circumstances, it uses the most appropriate interventions from an array of scientific disciplines to heal illness and disease and help people regain and maintain optimum health. The defining principles of integrative medicine are:
In addition to addressing the individual's immediate health problem(s) as well as the deeper causes of the disease or illness, integrative medicine strategies also foster the development of healthy behaviors and skills for effective self-care that patients can use throughout their lives. In the past 2 decades, integrative medicine has emerged as a promising model of care, increasingly finding a home in academic medical centers, hospitals, and healthcare systems. A growing body of evidence suggests that integrative medicine can successfully address—and to some extent, alleviate—many troubling aspects of our current healthcare crisis by helping to provide effective, safe, and cost-effective treatments as well as preventing future disease and fostering overall wellness. Moreover, integrative medicine holds special promise for reducing the burden of chronic illness on individuals and their families, and on the healthcare system.5,6 Previous studies examining this field have focused on the prevalence and use of complementary or alternative medicine (CAM) by patients1,2 or by practitioners in hospital settings. However, very little information has been collected regarding the actual practice of integrative medicine—as opposed to enumerating the use of single CAM therapies—at major centers across the United States. To better understand how integrative medicine is being practiced by clinics and hospitals, both inside and outside of academia, The Bravewell Collaborative commissioned a mapping study to: (1) describe the patient populations and health conditions most commonly treated, (2) define the core practices and models of care, (3) ascertain how services are reimbursed, (4) identify the values and principles underlying the care, and (5) determine the biggest factors driving successful implementation. (See Appendix 1 for information about The Bravewell Collaborative.) This study was conducted by:
As this is the first comprehensive survey of integrative medicine centers in the United States, the authors' initial task was to compile a list of centers for possible inclusion. This list included centers in the Bravewell Clinical Network and the Consortium of Academic Health Centers for Integrative Medicine as well as centers suggested by integrative medicine leaders. From the more than 60 centers identified, the authors chose 29 clinical centers and/or programs that they felt represented the field. This group included the 9 centers in the Bravewell Clinical Network plus 20 others that, directed by either a physician, other doctoral level healthcare provider, or nurse were chosen on the basis of length of time in operation (a minimum of 3 years), patient volume, and/or prior clinical contributions to the field. Centers whose clinical emphasis was solely on the delivery of non-Western or non-conventional care were excluded. It should be noted that, because of the nature and scope of the study, it was not possible to include all of the integrative medicine centers, programs, and clinics that exist across the nation, and that inclusion in the study is not a statement of endorsement. After the survey instrument was created, it was reviewed by Jeffrey Dusek, PhD, Research Director at the Penny George Institute for Health and Healing at Allina Hospitals in Minneapolis, Minnesota. (The complete survey instrument is included in Appendix 3.) Study data were collected and managed using REDCap (Research Electronic Data Capture) tools hosted at the University of California, San Francisco.7 REDCap is a secure, web-based application designed to support data capture for research studies. Twenty-nine (29) centers were invited to participate in the study. All 29 completed the survey. The survey questions were answered primarily by the director or clinical director of each center, sometimes in consultation with other center staff. To gather the qualitative data presented in this study, site visits were made to half of the centers with follow-up interviews by phone and/or email conducted with all centers. Michael Acree, PhD, senior biostatistician at the Osher Center for Integrative Medicine at the University of California, San Francisco, conducted the data analysis. The report was reviewed by Mimi Guarneri, MD, Scripps Center for Integrative Medicine; Benjamin Kligler, MD, Continuum Center for Health and Healing; and David Rakel, MD, University of Wisconsin Integrative Medicine. Integrative medicine is now an established part of healthcare in the United States. All of the centers in the study reported being affiliated with a hospital, a healthcare system, and/or a medical or nursing school.
The oldest center in the survey was established in 1988. The newest was established in 2008. Twelve (12) of the centers were established in the 1990s. Sixteen (16) of the centers were established since 2000. (Note: While most of the centers reported continued growth, one center in the study reported that it was being transitioned from a center to a program within the hospital to which it was affiliated.) (See Appendix 4 for the list of centers, their contact information, and affiliations.) (See Appendix 4 for a listing of the centers with addresses, affiliations, and website URLs.) 
Over the past 2 decades, different models of integrative medicine practice have developed. The 3 most common models in use (Figure 1 and defined below) are: (1) primary care, (2) consultative care, and (3) comprehensive care. Often, one center will utilize 2 or all 3 models of operation. Consultative CareIn the consultative care models (Table 1), the integrative physicians and practitioners work in close collaboration with the patient's primary provider. This is by far the most common model used in the centers.8
Examples of a consultative care model:
Comprehensive CareThe term “comprehensive care”was defined in the survey as “care for a specific condition.”In comprehensive care (Table 2), the integrative practitioner is the provider who manages the care during the course of treatment for a certain condition. In these instances, patients still have a primary provider for other health issues.
Examples of a comprehensive care model:
Primary CareIntegrative medicine centers that offer primary care employ family practice doctors, pediatricians, internists, and nurse practitioners who are also trained in integrative medicine (Table 3). These centers generally offer care for patients across the lifespan. Most centers that provide primary care also offer consultative and/or comprehensive care as well.
Examples of a primary care model:
Of the 29 centers surveyed, 15 offer inpatient services at their affiliated hospitals (Figure 2). Centers offering inpatient services. Examples of inpatient programs:
The centers in the study voiced a strong commitment to evidence-informed medicine, and most (25) conduct research as part of their regular activities (Figure 3). The broad spectrum of research programs range from the robust, multi-million dollar research programs at the University of Maryland Center for Integrative Medicine and the UCSF Osher Center for Integrative Medicine, both of which are NIH Centers of Excellence for Research; to ongoing research programs such as those at Duke Integrative Medicine, Vanderbilt Center for Integrative Health, Jefferson–Myrna Brind Center of Integrative Medicine, Continuum Center for Health and Healing, and the Integrative Medicine Program at Mayo Clinic; to single studies conducted at non-academic centers such as the Alliance Institute for Integrative Medicine's participation in BraveNet, a practice-based research network for integrative medicine established by The Bravewell Collaborative. While the research programs most typically conduct clinical trials, some centers such as the Penny George Institute for Health and Healing and the Marino Center for Integrative Health also conduct outcomes-based research in their hospitals and/or clinics. Nearly all the centers (25) were engaged in provider education (Figure 4). Centers offering provider education. The provider education offered by the centers takes many forms, such as designing medical and nursing school curricula, teaching medical and nursing school classes, offering fellowships, conducting grand rounds, providing continuing medical education (CME) courses, offering provider certification for credentialed positions including mindfulness meditation or yoga teachers or integrative health coaches, and producing local and national conferences for practitioners. The most frequently employed (full or part-time) practitioners at the integrative medicine centers in the study are physicians, followed by acupuncturists, massage therapists, meditation instructors, dieticians/nutritionists, and yoga instructors (Figure 5 and Table 4). Percentage of Centers Employing the Following Practitioners Either Full- or Part-time:
Some centers employ practitioners not listed in the survey. These included:
Because of the variation in the types of practitioners employed, during the site visits, the authors asked why, for example, a center would choose to employ a tai chi instructor instead of qi gong master, or why a center offered NIA instead of Pilates? For the most part, the center directors replied that this was a function of which practitioner had completed what training and was available in their locale, and not a function of whether they thought one modality was more effective than the other. Because the practice of integrative medicine involves the use of multiple therapies and healing systems for which specialized training is required, it is intrinsically collaborative. During the site visits and through written communication, the centers in the survey reported a high degree of collaboration among their practitioners. Many centers stated that collaboration was an important factor in clinical success. The following examples illustrate some of the diverse ways in which collaboration occurs:
The 29 centers see a total of 19,200 unique patients per month. The total number of patient visits per month for all centers is about 41,100. Overall, nearly two-thirds of the patients coming to integrative medicine centers are currently self-referred (63%). Nine centers reported that more than half of their patients are referred from within their own healthcare system, and 5 of the 9 reported receiving 90% or more of their patients from within their own healthcare system, suggesting a growing integration within the parent organizations. Most of the centers reported receiving a very low percentage of their patients from local practitioners outside their healthcare system. Examples of patient referral systems:
Most centers (20) do not require patients to see a physician when they first come to the center (Figure 7). Patients are allowed to schedule a visit with the provider of their choice. Several of the centers noted that when the integrative provider visit is based on self-referral, their practitioners are trained to identify when the patient should be referred to a physician or other primary care provider for medical assessment. The centers use a wide variety of triage and referral systems that do not require an initial physician visit. Examples of these systems:
Twenty-seven centers in the study reported making individualized care plans for their patients (Figure 8). Care plans are created in a variety of ways. In some cases the plan is created by the physician, naturopath, or nurse practitioner who is acting as the primary provider, with input from the patient. In other cases, the plan is developed by an individual practitioner or a team, which could include, in addition to the physician or other primary care provider, a nurse case manager, biofeedback practitioner, dietician, massage therapist, acupuncturist, psychologist, or TCM practitioner. Examples of how care plans are made:
Twenty-six centers reported incorporating the family into the patient's care (Figure 9). How this is accomplished ranges from including family members in practitioner visits to providing education to offering services targeted to family members. Family involvement in the care. Examples of family involvement:
The survey investigated the use of mind-body, dietary/biological, movement/energy, manual, and whole-systems (such as TCM and Ayurvedic) interventions. The authors tabulated the number of categories (mind-body, movement/energy, etc) used for any one specific health condition. In all cases, centers used interventions from more than one treatment category to address each health condition. Many of the physicians who participated in the survey told the authors that while the success of integrative medicine relies, in part, on the efficacy of the individual modalities used (eg, acupuncture, massage, nutrition, mindfulness), the greatest healing effect comes from taking a whole person approach — from treating the physical, emotional/mental, environmental, and spiritual aspects of the patient in tandem. Examples of treatment complexity:
Patient outcomes are observed and recorded in a variety of ways, the most common being through physician notes, patient comments, and patient satisfaction surveys (Table 5). How Outcomes Are Measured
Patient satisfaction is also measured in a variety of ways, the most common being surveys created by the centers themselves (Table 6). How Patient Satisfaction Is Measured
With the exception of data derived from clinical trials, most of the centers stated that, although they do capture patient outcomes data, they did not have the staff and financial resources to collect and analyze it. Integrative medicine emphasizes prevention—participating in those behaviors and actions that foster health and wellness. They include eating a healthy diet, exercising on a regular basis, providing clean air and water, eliminating toxins from the home and work environments, and taking steps to reduce daily stress levels. The economic importance of prevention lies in the fact that the majority of our healthcare dollars are currently spent after a person is already ill, when it costs the most to intervene and when the possibilities for full recovery are the slimmest.9 Integrative medicine practitioners have developed lifestyle intervention programs that help people make the changes needed to maintain and improve their health (Figure 11). Examples of lifestyle programs: Percentage of Centers Using Specific Lifestyle Change Interventions
Eight of the centers offer formal health coaching for patients (Figure 12), which helps patients shift their behaviors and realize their personal health goals. Centers offering health coaching. Some centers offer integrative health coaching through a certified health coach while in other centers, a physician, nurse practitioner, or other provider performs the health coaching function. Examples of health coaching programs:
Some integrative medicine clinics offer wellness programs so that healthy people can maximize their health and wellbeing. Examples of wellness programs:
Twenty-one centers (72%) reported offering self-care and wellness programs to their practitioners and staff. Examples of staff wellness programs:
Figure 13 shows the top conditions that were identified in response to the questionnaire item: “Please indicate the 5 conditions for which you are having the most clinical success.” The top 5 conditions reported by the centers were: chronic pain, gastrointestinal disorders, depression/anxiety, cancer, and stress. (See the complete list on pages 44–45.) On one hand, more than half of the centers listed having success with the same 5 conditions—chronic pain, cancer, gastrointestinal disorders, stress, and depression/anxiety—suggesting that integrative medicine holds promise for the treatment of these conditions. On the other hand, for every condition listed, there were at least 2 centers that reported having clinical success. This implies that the field might benefit from organized best practice sharing. The examples given below were gathered during follow-up communications and/or site visits and are not intended to imply support for the clinical efficacy of the approaches used, which is beyond the scope of this report. Chronic pain is the condition for which patients seek integrative care most frequently. Examples of how chronic pain is treated:
Sixteen of the centers (55%) reported having success with gastrointestinal disorders such as chronic constipation, irritable bowel syndrome, hemorrhoids, diverticular disease, and colitis. Examples of how gastrointestinal conditions are treated:
Depression/anxiety is one of the main reasons people seek care of any kind, conventional or integrative. Examples of how integrative medicine centers treat depression and anxiety:
While most cancer patients are referred from a conventional cancer treatment center, some patients self-refer to an integrative medicine center that is not directly involved in their cancer care. The integrative medicine centers in the study tended to offer emotional and nutritional support, as well as complementary therapies such as acupuncture and massage therapy to people who are undergoing, or have completed, cancer treatment. Examples of care for cancer patients:
Stress management is a major component of integrative medicine. Stress has been demonstrated to be an important risk factor for many health conditions. In addition, people with chronic health issues experience added stress from their illness. Directors of a number of the centers articulated a mission to help relieve suffering and offer hope to the people who come to them for healthcare. The therapeutic relationship is seen universally to be a key to relieving suffering, as is being in a healing environment. Examples of programs for stress reduction:
It should be noted that patients can use the skills they learn in MBSR, yoga, and other similar classes to continue effective self-care throughout their lifetime. Centers were asked which 5 of the 20 health conditions they believed their practitioners treated most successfully with integrative strategies. Table 8 shows the percentage of centers that stated the listed condition was among their top 5 most successfully treated conditions. (If a center did not treat a certain condition at all, it was not included in the numerical calculation.) Conditions for Which Centers Report Success
While there is a strong body of evidence supporting integrative medicine solutions for cardiovascular disease, heart disease and hypertension did not rank among the most successfully treated conditions. This may be related to the fact that only a handful of the centers in the study specialize in cardiac disorders. The survey asked about the use of 34 different interventions in treating 20 different conditions. The centers were asked to report which therapies they used for which conditions, the full data set of which is included in Appendix 5. The values reflect the positive number of responses out of 680 total possible (Table 9). Interventions Prescribed Most Frequently
The interventions prescribed most frequently by 29 centers across the 20 conditions, in descending order: Many of the centers reported using both mindfulness-based stress reduction and other types of meditation. When asked how practitioners “prescribed”a particular type of meditation, several directors reported that it was based on the patient's preferences and schedules. Those patients who were available to take an eight-week course were often encouraged to enroll in the mindfulness class while those whose schedules would not allow such formal participation, were taught to meditate on their own and recommended books and/or tapes. If the patient did not want to meditate, breathing exercises were used. This type of “listening”to the patient and tailoring the interventions to his or her own unique needs exemplifies patient-centered care. Figure 14 shows the reported use of the top 7 interventions for the 5 conditions for which centers feel they have the most clinical success. In the treatment of the 20 health conditions (Table 10, pages 44–45), 15 or more of the centers report that: Frequency of Use for All Interventions (by Number of Centers)
Figures 15 and 16 are 2 sample comparisons of the data showing the frequency of use among the different interventions for 9 conditions. (The full data set is included in Appendix 5.) These figures show that supplements and nutrition are used fairly consistently across conditions while there is greater variability in the use of the other interventions. To access the degree to which different treatments were used for different conditions, the frequency of use of each treatment for each condition was ranked. The correlation between the treatment ranks was then calculated. In reviewing the data, it should be noted that an acupuncture treatment for fatigue may not be the same as an acupuncture treatment for obesity as different meridian points may be chosen and/or different types of acupuncture utilized. The same is true for nutritional supplements. Those dietary supplements given to a heart patient may be different from those recommended to someone with cancer. Table 11 evaluated “types”of treatments, not specific treatments.
Table 12 on pages 48 and 49 shows the concordance and discordance of treatments for the 10 most frequently treated conditions. The higher the number, the greater the concordance. (See Appendix 6 for the complete chart of all conditions.) Differentiation of Treatments—Top Ten Conditions
The centers were asked to rate a series of value statements. The core values rated highest by the centers were treating the physical, emotional, and mental influences on health and delivering patient-centered care (Table 13). Percentage of Centers Marking Core Values as Very Important
Care at integrative medicine outpatient centers is paid for, in most cases, either by cash or through private insurance. In many cases, the insurance providers determine whether a service is covered or not, with the result that, for example, massage at the same center may be covered for one person and not for another. Figure 17 shows the percentage of centers receiving either cash or insurance for certain interventions. Cash and insurance reimbursement. While cash remains the most frequent form of payment, the interventions that have the highest frequency of insurance reimbursement are displayed in Table 14. Interventions With the Highest Frequency of Insurance Reimbursement
Table 15 shows, for a variety of conditions, how care is paid for—cash, insurance, or Medicare/Medicaid. Please note that percentages will not equal 100% as centers may take both cash and insurance for the same service, depending on the individual patient's coverage. In cases where the percentage is less than 100%, some centers did not offer those services.
One vehicle through which nearly half of the integrative medicine centers provide service and also generate income is the sale of vitamins, supplements, and herbal remedies as well as such products as tapes/CDs and books. Table 16 shows what percentage of centers handle the sale of these items. (NOTE: Percentages will not equal 100, as some centers may engage in more than one way of providing this service.)
Based on personal communication with each center's executive director or medical director, some of the key factors in an integrative medicine center's clinical success and long-term viability include: Clinical Success
The complete narrative for successful actions from each center is included as Appendix 7. The authors acknowledge the following challenges and limitations in conducting the study: One of the challenges of a survey such as this is identifying which centers to include or exclude. All of the centers surveyed have strong clinical programs, and nearly all of them see a large number of unique patients per month. In addition, centers selected to be surveyed were those that provided an integrative model in which conventional medicine plays an essential role. While these centers do, to some extent, provide care drawn from other health systems—including naturopathy, chiropractic, Traditional Chinese Medicine, Ayurveda, or homeopathy—centers whose sole orientation is to deliver healthcare from these non-conventional medical systems were excluded. The authors acknowledge that the responses may have been different if another cohort of centers was surveyed. The number of patient visits per center reflects the decision to treat centers with multiple locations differently. University of Wisconsin Integrative Medicine, for example, has three clinics; Marino has 2 locations; and Cancer Treatment Centers of America (CTCA) has 5 centers across the United States. For the purposes of this survey, Marino (despite its 2 locations) and University of Wisconsin Integrative Medicine (despite its 3 clinics) were considered to each be a single center with patient visit data included from their various locations. On the other hand, because of the magnitude of its size, data was collected from only 1 of the CTCA centers, its flagship hospital in Zion, Illinois. It is challenging to categorize therapies without some overlap. To be as inclusive as possible, some therapeutic approaches—such as supplements, vitamins, probiotics, and herbal remedies—were listed separately although “supplements”is a broad category under which the other three items could reasonably appear. Acupuncture was not listed separately as a therapy (although “acupuncturist”was listed in the practitioner section in addition to “traditional Chinese medicine”practitioner), while tai chi and qi gong were listed separately. So whether a center checked traditional Chinese medicine as a system of care was left to each center's discretion and own understanding of TCM. For example, a center could state that it offered tai chi and qi gong but did not offer TCM, if that center assumed that offering TCM would necessitate including acupuncture or traditional Chinese herbal remedies. With regard to medical conditions, acute and chronic pain were listed as separate conditions, as were specific pain-related conditions such as arthritis, fibromyalgia, and headache. These issues of classification should be carefully considered in the design of future studies investigating integrative care and the work of integrative medicine centers. This survey asked a number of questions concerning employees, but responses to these were excluded from the analysis to avoid misleading conclusions. For example, questions about total full-time and part-time employees did not differentiate between support staff and clinical staff. Consequently, some centers included administrative staff and others did not. The term “FTE”was not adequately defined—some centers included only people who were employed full time while other centers used “full-time equivalent”as the definition and included full-time positions that were filled by one or more practitioners. For the most part, the survey was completed by the director or medical director of each center. Whether or not they answered based on their own understanding of their centers or on a consensus basis is unknown. The authors acknowledge the possibility that different respondents from the same center might have answered the survey questions differently. The strong affiliations to hospitals, healthcare systems, and medical and nursing schools as well as the centers' collaborative work with, and growing referrals from, their own health systems reveal that integrative medicine is now an established part of healthcare in the United States. The number of centers included in this study who expressed to the authors that their patient numbers were growing and/or their roles in their respective healthcare systems were expanding, suggests an increasing acceptance of integrative medicine by the American public and the medical professions. As was well articulated by Benjamin Kligler, MD, and Roberta Lee, MD, in the textbook Integrative Medicine: Principles for Practice, “Integrative medicine is not synonymous with CAM.”10 This survey has shown that integrative medicine centers embrace a group of core values that inform and radiate through their practice and interactions with their patients. Integrative care is, in practice, patient-centered care and is a fundamentally collaborative enterprise fostering cooperation between patients and practitioners, and among the practitioners themselves. To assess the degree to which different treatments were used for different conditions, the frequencies of treatments for each condition were ranked. Then, for each pair of conditions, the correlation between treatment ranks was calculated. This analysis revealed that there was a high degree of concordance of interventions used for similar clinical conditions. The fact that integrative medicine is being practiced in diverse sites across the country with high levels of concordance of interventions for specific conditions suggests that the practice is informed by a common knowledge base. One of the most striking, though perhaps predictable, conclusions of this study is that integrative medicine is, in fact, integrative. It integrates conventional care with non-conventional or non-Western therapies; ancient healing wisdom with modern science; and the whole person—mind, body, and spirit in the context of community. Based on the findings of the questionnaire (see Appendix 3) and supplemental interviews with integrative medicine center leaders, the authors make the following recommendations: Outcomes DataMost integrative medicine centers have collected a wealth of data on their patients and their treatments, including outcomes data. However, many centers report that they are unable to analyze and disseminate these data because of limited human and financial resources. Providing funding for analysis of these data, which could yield important information about the treatment efficacy of integrative medicine approaches, as well as the treatment of chronic health conditions, should be a priority for funding sources and institutions. Cost-Effectiveness DataFuture research on approaches used by integrative medicine centers should include measures to determine cost and relative cost-effectiveness of treatments for specific conditions. Best PracticesThe field of integrative medicine is still being developed. Systems to further identify and share best practices among integrative medicine centers and practitioners need to be developed. The Bravewell Collaborative's Best Practices Program and Best Practices in Integrative Medicine: A Report11 from the Bravewell Clinical Network are examples of models for sharing best practices in the field. Follow-up SurveyIn order to track the progress of integrative care, a follow-up survey in three to five years, building on the questionnaire employed in this report, should be conducted. Comparing the results reported here with those to be found in future reports may be helpful in identifying innovation and trends in the delivery, effectiveness, and use of integrative care. This information can then be leveraged to provide higher quality, more effective, and more patient-centered healthcare at integrative medicine centers throughout the United States. Throughout American history, philanthropy has served as a catalyst for social change. In 2002, aware that the healthcare system in our country was in crisis, a small group of dedicated philanthropists joined in conversation with leading physicians in the field of integrative medicine to discuss the potential benefits that might be derived from collaboration. Two key questions were discussed: Could a group of philanthropists working together to fund strategic programs aimed at systems change accomplish more than individual philanthropists working alone? Did the field of integrative medicine hold some of the answers to our healthcare system's problems? In both cases, the answer to the question was “yes.” Following that and a subsequent meeting, The Bravewell Collaborative was established as an operating foundation dedicated to transforming the culture and delivery of healthcare. Working as an innovative community by learning, identifying, planning, and funding highly strategic and leveraged initiatives, Bravewell supports rigorous research and scientific approaches in the entirety of its work, and frequently acts in partnership with like-minded institutions and individuals. Bravewell believes that by shifting the focus of the healthcare system to prevention, health maintenance, early intervention, and patient-centered care, integrative medicine holds the power to transform the economic models that drive and impede our present healthcare system and improve public health, which is essential to our nation's future. By developing strategic programs that support innovation and integrative approaches to medicine, The Bravewell Collaborative believes that it can direct positive and lasting change in our healthcare system. More information about each of the initiatives can be found at www.bravewell.org. In 2003, to help develop effective clinical models for the delivery of integrative health-care, The Bravewell Collaborative established a network of 8 leading integrative medicine centers. Bravewell assists the Clinical Network members in building the capacity to serve patients, developing successful models of care, and improving financial sustainability. Today, the nine centers in the Clinical Network provide integrative care to thousands of people across the nation. The Network's progress was documented in the 2007 publication of Best Practices in Integrative Medicine: A Report from the Bravewell Clinical Network, which is available at www.bravewell.org. To help train new clinical leaders in the field of integrative medicine, The Bravewell Collaborative created the 2-year Bravewell Fellowship Program in conjunction with the highly-respected Fellowship Program at the University of Arizona's Center for Integrative Medicine. As of 2010, 75 Fellows have graduated from the program, with another 18 currently enrolled. Because the graduates typically return to leadership positions within their organizations, this program is exponentially increasing the availability of integrative medicine for the American people. Recognizing the pressing need for research that would document the cost and clinical effectiveness of integrative care, The Bravewell Collaborative established BraveNet, the first practice-based research network for integrative medicine. Under the direction of the Duke Clinical Research Institute, BraveNet researchers are currently completing their second study. More information on BraveNet is available at bravenet.dcri.duke.edu. With Bravewell's financial support, the Consortium of Academic Health Centers for Integrative Medicine has grown from its four founding members to a strong organization of 50 member schools. This network of clinical centers connected with leading medical universities in the United States and Canada is helping to transform research, patient care, and physician education. More information about the Academic Consortium and a complete list of member schools is available at www.imconsortium.org. Understanding that educating the public is key in the effort to transform our healthcare system, Bravewell organized and its members helped fund an award-winning two-hour PBS Special on integrative medicine. The New Medicine aired on March 29, 2006 on 516 PBS stations nationwide during prime time and was viewed by over 4.2 million people, with repeat broadcasts ongoing. For more information about The New Medicine, please visit www.thenewmedicine.org. The Bravewell Leadership Award and the Bravewell Pioneers of Integrative Medicine Awards recognize, empower, and support the physician leadership in this field. In 2003, Ralph Snyderman, MD, former Chancellor for Health Affairs, Duke University Medical Center, accepted the $100 000 Leadership Award. In 2005, Brian M. Berman, MD, Director of the Center for Integrative Medicine at the University of Maryland School of Medicine, accepted his award. In 2011, the third Leadership Award was presented to Mimi Guarneri, MD, founder and Medical Director of the Scripps Center of Integrative Medicine. The Inaugural Pioneers of Integrative Medicine Award Event in November 2007 honored 6 early leaders of integrative medicine—Larry Dossey, MD; James Gordon, MD; Jon Kabat-Zinn, PhD; Dean Ornish, MD; Rachel Naomi Remen, MD; and Andrew Weil, MD. In partnership with The Bravewell Collaborative, the Institute of Medicine at the National Academies of Science convened a Summit on Integrative Medicine and the Health of the Public on February 25–27, 2009 in Washington, DC. This ground-breaking Summit explored the science and practice of integrative medicine for improving the breadth and depth of patient-centered care and promoting the nation's health. For more information about the Summit please visit www.iom.edu/integrativemedicine. To view the Summit lectures, please visit www.imsummitwebcast.org. To further enhance the adoption of integrative medicine, Bravewell developed a series of targeted educational documents and videos that are offered free from its website. These include the reports Integrative Medicine: Improving Health Care for Patients and Health Care Delivery for Providers and Payors; The Efficacy and Cost Effectiveness of Integrative Medicine; and What Is Integrative Medicine, as well as 12 physician training videos focusing on the patient-provider relationship. Bravewell's Best Practices Program highlights proven clinical interventions and/or business procedures through the publication of exemplars on www.bravewell.org. In June 2010, senior military medical leadership met with The Bravewell Collaborative and scientists, physicians, and health system leaders to discuss improving pain management for warriors and veterans through the use of integrative medicine. This meeting, held at the Pentagon, was part of the Army's effort to provide “a standardized DoD and VHA vision and approach to pain management to optimize the care for warriors and their families.”Symposium participants reviewed the latest science in pain management and how integrative interventions can not only help improve pain management but also advance the overall health and “mission readiness”of the DoD and VHA, which is vital to the safety of our nation. Donald I. Abrams, MD, is chief of the Hematology-Oncology Division at San Francisco General Hospital, an integrative oncologist at the UCSF Osher Center for Integrative Medicine and Professor of Clinical Medicine at the University of California, San Francisco. He graduated from Brown University in 1972 and from the Stanford University School of Medicine in 1977. After completing an Internal Medicine residency at the Kaiser Foundation Hospital in San Francisco, he became a fellow in Hematology-Oncology at the UCSF Cancer Research Institute in 1980. During his fellowship, Dr Abrams spent eight months working in the retrovirology laboratory of Harold Varmus, MD, during the time that the first cases of AIDS were being diagnosed. He subsequently returned to the clinical arena where he was one of the original clinician/investigators to recognize many of the early AIDS-related conditions. He conducted numerous clinical trials investigating conventional as well as complementary therapies in patients with HIV including therapeutic touch, traditional Chinese medicine interventions, medicinal mushrooms, medical marijuana, and distant healing. Dr Abrams' interest in botanical therapies led him to pursue a 2-year Fellowship in the Program in Integrative Medicine at the University of Arizona, which he completed in December 2004. His particular passion in the field involves nutrition and cancer. Since completing his Fellowship, Dr Abrams has been providing Integrative Medicine consultation to people living with and beyond cancer at the UCSF Osher Center for Integrative Medicine where he served as Director of Clinical Programs from 2006 to 2008. His research interests in integrative oncology are in medicinal mushrooms, traditional Chinese medicine interventions, and nutrition. He co-edited an Oxford University Press textbook, Integrative Oncology, with Andrew Weil, MD, and is a member of the NCI PDQ CAM Editorial Board. Dr Abrams was President of the Society for Integrative Oncology in 2010. Bonnie J. Horrigan is the Director of Communications and Public Education for The Bravewell Collaborative. The author of Red Moon Passage (Harmony, 1996) and Voices of Integrative Medicine: Conversations and Encounters (Elsevier Science, 2003), she has published more than 200 articles in Spirituality & Health; Science & Spirit; CHOICES; The Inner Edge; Advances in Mind-Body Medicine; Alternative Therapies in Health and Medicine; EXPLORE: The Journal of Science and Healing; and San Diego Magazine, among others. Horrigan has also penned 3 national reports for The Bravewell Collaborative—Best Practices in Integrative Medicine, Integrative Medicine: Improving Health Care for Patients and Health Care Delivery for Providers and Payors, and The Efficacy and Cost Effectiveness of Integrative Medicine. In 1995, Bonnie co-founded (with Larry Dossey, MD, and Jeanne Achterberg, PhD) Alternative Therapies in Health and Medicine, a medical journal examining alternative and cross-cultural healing practices and the relationship of the human spirit to health and healing. She is currently editorial director for EXPLORE: The Journal of Science and Healing, a new, indexed medical journal that examines the healing arts and the connection between spirituality and consciousness and health. Prior to working for Bravewell, she served as Director and then President of InnoVision Communications in Laguna Niguel, California (1990–2001) and Vice President of the Publishing House in Westminster, Colorado (1980–1989). Sheldon Lewis has served as Editor-in-Chief of Advances in Mind-Body Medicine and as a Contributing Editor for Spirituality & Health magazine. He is co-author of the books The Human Side of Cancer and Stress-Proofing Your Child and magazine and journal articles. He currently serves as a media and program consultant in the fields of health and business. He leads Meditation/Contemplative Practice groups and workshops and Mind/Body/Spirit groups in New York City and at The Center for Women's Health in Stamford, Connecticut. He completed the Center for Mind-Body Medicine's Advanced Professional Training in Mind-Body Medicine. He served on the advisory panel for EDCAM, the NIH-sponsored American Medical Student Association initiative to develop medical school curricula on Complementary & Alternative Medicine. He currently serves as Chairman of the Board of The Knowledge Project, which provides literacy and mentoring programs to New York City public school children and their teachers. Constance Pechura, PhD, is a Senior Advisor to The Bravewell Collaborative for Integrative Medicine. From 2006 until 2011, she was the Executive Director of the Treatment Research Institute (TRI) in Philadelphia and an Adjunct Associate Professor of Neuroscience in the Department of Psychiatry at the University of Pennsylvania. From 1998 to 2006, Dr Pechura was Senior Program Officer at The Robert Wood Johnson Foundation, including leading the Human Capital Portfolio. From 1988 until 1998, Dr Pechura was a member of the senior staff at the Institute of Medicine/ National Academies of Science, including serving as Director of the Institute's Board on Neuroscience and Behavioral Health. Dr Pechura taught health policy in the Stanford in Washington Program from 1993 to 1998 and anatomy and neuroscience courses at George Washington University Medical School and the F. Edward Hebert School of Medicine at the Uniformed Services University of the Health Sciences. Dr Pechura has a B.S. in Psychology at Virginia Commonwealth University and a PhD in Anatomy, with a specialization in Neuroscience, from the Uniformed Services University of the Health Sciences (USUHS). Awards include a National Science Foundation Graduate Fellowship, an Outstanding Teaching award from the USUHS Medical School Class of 1988, and the National Research Council's Special Achievement Award in 1993. This Mapping Survey is being conducted on behalf of The Bravewell Collaborative by Donald Abrams, MD, Bonnie Horrigan, Sheldon Lewis, and Connie Pechura, PhD. Its purpose is to discover how integrative medicine is being practiced throughout the US, understand what conditions are being treated successfully and identify emerging models of integrative care. The Bravewell Collaborative intends to use this information to help providers and administrators within all of healthcare understand the value of integrative approaches. You and your center will be identified as a participant in the final, written report, which will be distributed nationally. The survey is detailed. If you cannot complete the entire survey in one setting, the survey tool will save your responses and you can return to it at a later time. We would like to receive all responses by May 31, 2011. Thank you for your time and effort in completing this survey. Should you have questions, please contact Bonnie Horrigan at ten.xoc@nagirroheinnob or (760)-634-4947. PATIENTS AND PROVIDERS
CARE PLANS AND RECORDS
MIND-BODYFor the conditions listed below, please indicate the mind-body interventions you use the most. (Check all that apply.)
MIND-BODYFor the conditions listed below, please indicate the mind-body interventions you use the most. (Check all that apply.)
DIETARY AND BIOLOGICAL INTERVENTIONSFor the conditions listed below, please indicate the dietary or biological interventions you use the most. (Check all that apply.)
MOVEMENT/ENERGY INTERVENTIONSFor the conditions listed below, please indicate which movement/energy interventions you use the most. (Check all that apply.)
MANUAL INTERVENTIONSFor the following conditions, please indicate the manual interventions you use the most. (Check all that apply.)
MEDICAL SYSTEMSFor the following conditions, please indicate the medical systems you use the most. (Check all that apply.)
RETAILPlease indicate how you offer patients the opportunity to buy:
PREVENTION AND WELLNESS
FINANCIALHow do patients pay for the following services? (Check all that apply.)
PHILOSOPHYBelow is a list of philosophical statements about integrative medicine. Please indicate the importance of each statement for your center.
FINAL QUESTION
Alliance Institute for Integrative Medicine*
Arizona Center for Integrative Medicine
Cancer Treatment Centers of America
The Center for Integrative Medicine
Center for Life
Cleveland Clinic Center for Integrative Medicine
Continuum Center for Health and Healing*
*Denotes membership in the Bravewell Clinical Network 11th Street Family Health Services of Drexel University
GW Center for Integrative Medicine
Greenwich Hospital Integrative Medicine Program
Institute for Health & Healing at California Pacific Medical Center
Jefferson–Myrna Brind Center of Integrative Medicine*
Marino Center for Integrative Health
University of Maryland Center for Integrative Medicine*
Integrative Medicine Program, Mayo Clinic
Integrative Medicine Center at MD Anderson Cancer Center
Northwestern Integrative Medicine
The OSU Center for Integrative Medicine
Osher Center for Integrative Medicine*
Osher Clinical Center
Penny George Institute for Health and Healing*
Scripps Center for Integrative Medicine*
Simms-Mann Health and Wellness Center at Venice Family Clinic*Center for Integrative Medicine and Wellness at Stamford Hospital
Stanford Center for Integrative Medicine
Susan Samueli Center of Integrative Medicine
University of Wisconsin Integrative Medicine
Vanderbilt Center for Integrative Health
GASTROINTESTINAL DISORDERS
The following vignettes were developed from the answers each center provided to the question: To what do you attribute your success? Alliance Institute for Integrative Medicine cites strong medical leadership; a commitment to hiring only highly trained, effective practitioners; scheduling systems that provide for high utilization; and the development of specialized interventions such as their ACE Treatment, which “dips the patient in wellness”as keys to its success. The directors also believe that maintaining respectful relationships with their patients' primary providers has built trust in the community and enabled referrals to their center to grow. This center has found its in-depth integrative medicine consultations to be highly successful. The physicians encourage patients to tell their full story, allow for ample time, listen carefully to discern what might help a patient heal, and work in partnership to develop a treatment plan. Supportive ongoing consultative care helps patients make lifestyle changes. A multi-disciplinary patient conference is also highly valued by patients. Cancer Treatment Centers of America's success is rooted in its vision to provide integrative, compassionate cancer care based on what cancer patients value. The CTCA model of full integration between conventional cancer treatment and complementary approaches is aimed at treating the whole person, managing side effects, and improving quality of life. This model is attractive to their patients, 90% of whom refer themselves to CTCA. Integrative Medicine at the University of Colorado Hospital owes its success to word-of-mouth referrals and the fact that the center is highly valued by other physicians and health-care professionals in the university's health system. At the Center for Life, practitioners focus on empowering their patients to manage their symptoms and side effects; being a place of “hope”and a home away from home; and honoring each patient's story. Integrative medicine has become an integral part of services offered by the University of New Mexico, resulting in approximately 70% of patient referrals coming from primary and specialty care physicians within the UNM community. The medical director and practice manager have developed team strategies that place the patient at the center of their larger healthcare team, resulting in high patient satisfaction and financial viability. A key factor in the Cleveland Clinic Center for Integrative Medicine's success has been its ability to creatively meet the needs of its community, including the goal of keeping patients' outof-pocket expenses down. The center's innovations include its popular holistic psychotherapy, using mind-body and expressive therapies to facilitate mind-body-spirit healing. In the past 11 years this center has grown from a small start-up to a fully recognized department within the Beth Israel Hospital system. Contributing to its success are its strong service lines—family practice, women's health, physiatry, and physical therapy—effective staffing, and its commitment to evidence-informed practice. Also contributing to its success is the development of strong relationships within the overall health system and being able to effectively document treatment success. Duke Integrative Medicine cites its alignment with the culture and mission of the Duke University Health System and Medical School as central to its success. Partnerships with and among other entities result in innovative opportunities for system integration and innovation. A diverse portfolio of initiatives—clinical services, professional development, research, and medical education—fuel the growth and development of the institution. Multi-year business planning and a strong philanthropic program provide infrastructure and support. The 11th Street Center in Philadelphia reports that its success is rooted not in the structure and programs of its integrative model, but in its staff's belief in integrated care. “It works because we make it work,”says the director. The center promotes collaboration among primary care providers, behavioral health consultants, and other healthcare professionals, including a complementary and integrative therapist, who offers patients such healing practices as yoga, meditation, reiki, reflexology, and Mindfulness-Based Stress Reduction. According to the director, the center's trans-disciplinary approach fosters flexibility and cooperation and improves efficiency and quality of care. The GW Center for Integrative Medicine's healthcare team sees its expertise, as well as communication and collaboration among practitioners, as contributing to its success. The team draws from core values that extend beyond the use of natural treatments—άgreen allopathy.” Respect for patients is also seen as key. “There are no white coats here,”says its director. “Patients sit next to their doctors as equals.” The Integrative Medicine Program at Greenwich Hospital in Connecticut attributes its results to its approach with the patient—honoring the patient's experience and taking the time for the patient's story and concerns to be heard—as well as a commitment to find and treat the root causes of the patient's condition. IHH attributes its success to implementing a shared and meaningful vision and mission. “Every interaction we have is meant to be a healing encounter,”says the director. Developing collaborative programs, staying nimble as an organization, and running the center in a financially sustainable way are also contributing factors. Other strong elements in their success are treating every patient as an individual by not limiting themselves clinically to set protocols and holding a weekly provider conference to discuss cases. Moving the location of the center from “off-site”to “on-site”; creating programs that target specific local markets; the development of an Integrative Medicine Grand Rounds program for the larger health system; building bridges to the Jefferson Kimmel Cancer Center, and strong community outreach are the main actions contributing to this center's success. According to the Marino Center, the following factors drive successful implementation of its integrative healthcare program: Hiring practitioners who are both skeptical and open-minded about integrative care; maintaining a balance between conventional primary care and complementary therapies; fulfilling the mission to facilitate healing of mind, body, and spirit, using science and wisdom while being financially sound; and developing research and education programs, as well as a standardized approach to care. The Center for Integrative Medicine at the University of Maryland cites its leverage of initial philanthropic support for research into an internationally-acclaimed, robust research program as the biggest factor to its success. Building bridges within the University of Maryland medical system, especially to Kernan Hospital and the R Adams Cowley Shock Trauma Center, and maintaining a focus on Traditional Chinese Medicine and pain management also helped this center grow in stature over the 20 years it has been in operation. One of the factors in the Mayo Clinic Integrative Medicine Program's success is its location in the department of medicine. Internal collaborative research that has been shared with colleagues to demonstrate the safety and efficacy of integrative approaches, along with collaborative partnerships with specialty areas focusing on patients' holistic care needs, has also helped to gain the respect of medical colleagues, which leads to referrals to the integrative medicine program. MD Anderson's Integrative Medicine Program attributes its success to using an evidence-based approach to the services it provides and having a strong focus in research. Collaboration and open communication between the integrative healthcare team and the referring oncology team is also critically important. A weekly interdisciplinary team meeting of healthcare professionals to discuss challenging cases includes integrative oncologists, massage therapists, acupuncturists, dieticians, massage therapists, mind-body practitioners, mental health workers, occupational and physical therapists, chaplains, etc. Northwestern Integrative Medicine attributes much of its success to its unique relationship to its academic health center, having been developed by Northwestern Memorial Hospital's primary care group, as well as its strong relationship with the Feinberg School of Medicine. Another strong factor is the collaboration between the medical and business sides of the center, including fundraising through its Philanthropic Advisory Council for donor-driven programs such as its 360 Integrative Oncology Program. This center has its roots in a tripartite mission, attempting to effectively mainstream and integrate complementary and alternative services into the traditional medical model through research, education, and dedicated delivery of compassionate and comprehensive integrative healthcare. Through the expertise of talented clinicians, an undergraduate educational program, and growing research in integrative medicine, Ohio State has successfully established a presence of integrated medical care in central Ohio. Attracting talented, multi-disciplinary faculty to lead the three focus areas—research, clinical care, and education—and having these 3 areas work synergistically have been the key strategies in the UCSF Osher Center's success. Building bridges to other centers and institutes within the UCSF medical system, such as the cancer center, developing a strong philanthropic community, and having good core business practices have also contributed to its success. What drives the Osher Center's success is having an effective front desk for triage, counseling, and “customer service”; expert practitioners; a healing environment; a full-time medical director; and a mandatory weekly conference for staff. An additional factor is that the center's clinical staff respect each other as professionals who have the expertise to know when to use which therapy, which ones are safe, and what the risks and benefits are. The Penny George Institute attributes it success to developing collaborations with physicians and healthcare administration as well as using evidence-based therapies; providing a strong service line to both inpatients and outpatients; educating its own staff as well as other healthcare professionals; a strong community outreach program that promotes prevention and personal responsibility for health; and conducting research to identify best practices and demonstrate the economic impact of integrative health. Strong leadership at the top, building a committed core of highly trained integrative practitioners, “practicing what you preach,”and specializing in cardiac care and pain management have been key to the Scripps Center for Integrative Medicine's success. Building a strong group of supportive philanthropists and nurturing relationships within the larger Scripps system also has brought stability and growth opportunities to the center. Because the Venice Family Clinic is a free clinic, the center has developed strong partnerships with the local medical, chiropractic, massage, and acupuncture schools, and many of their students volunteer at the center, providing services free of charge, which has then enabled the center's programs to grow. Other factors contributing to its success are strong medical leadership, inspired staff, and philanthropic support. Stamford Hospital's Center for Integrative Medicine's success is due to its problem-solving model; its referrals from physicians in the hospital system and credibility in the local medical community; its consultation practice that adds value to, but does not compete with, local physicians; and the fact that its practice has a high volume of patient visits and is insurance-based. The Stanford Center has realized success through its strong focus on cancer and pain patients, a robust mindfulness program, and building bridges within the greater Stanford medical system with clinicians who have outstanding expertise in their treatment areas, many of whom also engage in treatment-related research. The center engages in treatments that have an evidence base, and a combination of careful assessment with evaluation of treatment outcome, and follow the mandate that “a good doctor treats the disease, but a great doctor treats the patient.” Some of the biggest factors driving the success of the Samueli Institute's program are the collaborative work between practitioners through referrals to, or consultations with, other providers at the center, such as a naturopath or acupuncturist. Other factors include bi-weekly provider meetings, support from the front-office staff, a strong community education program, strong support from the Center's Advisory Board, and positive results—which lead to more word-of-mouth referrals. One of the key factors in the success of the University of Wisconsin's Integrative Medicine center is its strong presence in the community, according to its director. In addition to having two community-based clinics that provide primary, consultative, and comprehensive care, the center also has a growing relationship with the university's oncology clinic. One of the factors contributing to the success of Vanderbilt's Center for Integrative Medicine is its healing environment: the clinic was designed with soothing colors, gentle lighting, and comfortable seating. To address the whole person, patients being treated at the center—regardless of their specific condition—generally work with a number of team members, feel very supported and respected on their journey, are encouraged to increase their social support through group offerings, are followed often and for at least a year, and learn mindfulness skills through a variety of ways (mindfulness for pain classes, Mindfulness-Based Stress Reduction classes, mindful movement such as yoga or qigong). The clinician-patient relationship is emphasized and reinforced through all of the center's efforts. To learn more about integrative medicine please visit www.bravewell.org. Questions about this survey or requests for more information should be directed to Bonnie Horrigan, Director of Communications and Public Education, The Bravewell Collaborative. (760) 815-0238 or ten.xoc@nagirroheinnob. Bonnie Horrigan, Bonnie Horrigan is Director of Communications and Public Education at The Bravewell Collaborative, United States. Sheldon Lewis, Sheldon Lewis is an Editorial and Communications Consultant, United States. Donald I. Abrams, Donald Abrams, MD, is an integrative oncologist at the UCSF Osher Center for Integrative Medicine and Professor of Clinical Medicine at the University of California San Francisco, United States. Constance Pechura, Constance Pechura, PhD, is Senior Scientific Advisor at The Bravewell Collaborative, United States. 1. Barnes PM, Bloom B, Nahin R. CDC National Health Statistics Report #12. The Use of Complementary and Alternative Medicine in the United States. Findings from the 2007 National Health Interview Survey (NHIS) conducted by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Center for Health Statistics. December2008. http://nccam.nih.gov/news/camstats/2007/cam-survey_fs1.htm Accessed November 5, 2011. [Google Scholar] 2. Eisenberg DM, Davis RB, Ettner SL, et al. Trends in Alternative Medicine Use in the United States, 1990–1997: Results of a Follow-up National Survey. JAMA. 1998;280(18):1569–1575 [PubMed] [Google Scholar] 3. Ananth S. 2010 Complementary and Alternative Medicine Survey of Hospitals: Summary of Results. Health Forum (American Hospital Association) and the Samueli Institute. September2011. http://www.siib.org/news/2468-SIIB/version/default/part/AttachmentData/data/CAM%20Survey%20FINAL.pdf Accessed December 11, 2011. [Google Scholar] 4. See http://bravewell.org/integrative_medicine/what_is_IM/ For additional definitions please see: The Consortium of Academic Health Centers for Integrative Medicine. http://www.imconsortium.org/about/home.html Accessed October 6, 2011. Arizona Center for Integrative Medicine at the University of Arizona; http://integrativemedicine.arizona.edu/about/definition.html Accessed October 11, 2011. [Google Scholar] 5. Guarneri E, Horrigan B, Pechura C. The Efficacy and Cost Effectiveness of Integrative Medicine: A Review of the Medical and Corporate Literature. Explore: The Journal of Science and Healing. 2010; 5:308–312 [PubMed] [Google Scholar] 6. Maizes V, Rakel D, Niemiec C. Integrative medicine and patient-centered care. Explore: The Journal of Science and Healing. 2009;5(5):277–89 [PubMed] [Google Scholar] 7. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) — A metadata-driven methodology and work-flow process for providing translational research informatics support. J Biomed Inform. 2009; 42(2):377–81 [PMC free article] [PubMed] [Google Scholar] 9. Horrigan B. What is Integrative Medicine? Published by The Bravewell Collaborative; 2010. http://www.bravewell.org/integrative_medicine/what_is_IM Accessed November 6, 2011. [Google Scholar] 10. Kligler B, Lee R. Integrative Medicine: Principles for Practice. New York: McGraw-Hill, 2004, xvii [Google Scholar] 11. Best Practices in Integrative Medicine: A Report from the Bravewell Clinical Network. 2007 edition [Google Scholar] |
The system of medicine that embraces methods of proven value in the treatment of disease is
Postagens relacionadas
direito autoral © 2024 aprendervalor Inc.
