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Table 1 Key characteristics of care of IHC centres

From: The process of care in integrative health care settings – a qualitative study of US practices

Centre Business structure Practitioners and services Summary of clinical process Research performed
UCLA Centre for East–west Medicine Consultant care, University based P/T and F/T salaried CM staff Practitioners: 6 MDs (salaried), 5 clinical specialists (salaried acupuncturists, &/or massage therapists) Patients may be referred to the clinic or attend directly. There are around 500 physicians who refer directly to the Centre. An initial patient intake form is provided and the patient seen by an MD with some background in Chinese medicine. Treatment is individualised and provided by the dual trained physician or through referral from the MD to one of the other practitioners. No protocols or guidelines are used. Yes
Services: comprehensive consultation, patient education on self-care techniques, medication adjustments, lifestyle coaching and diet recommendations, acupuncture, trigger point injections, and myofascial release/therapeutic massage. The Centre is in the process of being able to offer primary care services in addition to consultative. The full implementation of Electronic Health Records (EHR) occurs late 2013. Currently, patient charts are on paper but will transition into electronic copies. When EHR is implemented, charting, scheduling, notes, pharmacy requests, and et cetera will all be completed electronically. Every patient encounter will be logged, monitored, and shared with the next practitioner at UCLA Health.
Special clinics: Breast Cancer, Head and Neck diseases, Inflammatory conditions, Oesophageal disorders
The Penny George institute for Health and Healing - Abbott Northwestern Hospital Hospital inpatient The hospital has an integrative medicine team of 7 experienced acupuncturists and other CM practitioners including aromatherapy, art & music therapy, guided imagery, energy healing, massage, Korean hand therapy, reflexology and relaxation techniques. Staff are salaried. Hospital: Referrals are provided by nurse or physician, the patient may also request the service but it must have any treatment from the acupuncturist signed off by the physician. Some guidelines for referrals for pain, anxiety, elimination problems, nausea or vomiting. Common charts are used which record time, reason, SOAP, pain, anxiety and nausea scores. Morning meetings between the IM team enable patients to be discussed and allocated. Biweekly case conferences. Practitioners have training in IM principles and modalities and team work. CM practitioners may ‘round’ with conventional medical practitioners. Systematic recording of before and after of pain. Yes
Part of Allina Health
Salaried CM staff.
Outpatient clinic Part of Allina Health The Outpatient Clinics offer individual and group acupuncture sessions, Traditional Chinese Medicine, resilience training, nutritional counselling, Mindful eating workshops, massage, wellness visits, exercise physiology consults, biofeedback Clinic: referrals or self-referral. Patients may have a joint consult with an MD and nurse practitioner or clinician to understand integrative health therapies.
Salaried or Fee for service?
Beth Israel Hospital Hospital Part of Continuum Health Partners Inc (not for profit org) Volunteer and paid CM staff Practitioners: Acupuncturists, Reiki practitioner, Yoga therapists Inpatient services can be accessed by contacting the program coordinator or by referral from other staff. Acupuncture services require sign off by the physician. The hospital operates a volunteer acupuncturist intern program at the hospital. The acupuncturists treat pain, anxiety and nausea. Systematic recording of before and after of pain. Details, history and documentation of the program are shared. Yes
Services: Holistic Preparation for Surgery Program, Acupuncture, yoga therapy program, healing touch program, contemplative care services
Primary care consultants P/T and F/T CM staff Practitioners: IM MDs, MDs with speciality areas including cardiology, ENT, sports medicine and rehabilitation, Gynaecologist, Podiatrist, Physical Therapist, Nutritionist, Chiropractor (also an acupuncturist), Acupuncturists, Nurse Practitioners (one is also a homeopath) , Patients can make an appointment with any practitioner, be referred internally or externally. Practitioners share common electronic medical records. Practitioners have own offices and treatment rooms. Fortnightly meetings are held for practitioners and others to attend. Topics may be an integrative approach to a particular condition or complex cases may be presented for feedback. Yes
Services: internal medicine, cardiology, dermatology, family medicine, orthopaedic and sports rehabilitation, physical Therapy, occupational and hand therapy, gynaecology, ear, nose and throat; chiropractic; podiatry, nutrition, psychotherapy and stress management, acupuncture and East Asian medicine, massage, integrative therapies, fitness centre, yoga therapy, mindfulness meditation, Dean Ornish Heart Disease Reversal Program, fitness centre
Casey Health Institute Family medical centre, privately owned P/T and F/T salaried CM staff Practitioners: MDs, Nurse practitioner, Naturopath, Chiropractor, Acupuncturist, Massage therapist, Reiki master, Nutritionist, Psychologist, Patients can make an initial appointment with any practitioner or schedule wellness service/class. There is no physician gatekeeper. Practice is organized around a central team room where practitioners are constantly discussing integrative treatment of patients informally and cross referring In addition to regular weekly required Integrative Case conferences and separate weekly integrative didactic meetings. Shared electronic medical records with capability of tracking medical and economic outcomes data. All practitioners have access to records. One of a small number of Integrative Primary Care centres that takes all insurance, Medicare, Medicaid and will also be a level III Patient Centered Medical Home. Yes
Services: primary care, acupuncture, massage, naturopathy, chiropractic, psychology, therapeutic yoga, fitness classes, health coaching, patient navigator, pilates, zumba, reiki, a range of wellness workshops
Staff are salaried, mostly full time.
IMCSR Family medical centre, privately owned P/T and F/T staff are fee for service Integrative medicine physician, two naturopaths, acupuncturist, a feldenkrais practitioner, nutritionist and chiropractor. Staff are fee for service. Self-referral to any practitioner. IM physician may suggest treatment with other practitioners. Communication about patients through shared medical records? Offers a free-of-charge 10–15 min consultation to clarify which provider and/or service. Another option is to use a patient navigator (licensed social worker) who is available, for a fee, to offer guidance about choices of modalities, practitioners and approaches to your health and healing. There are some individualised integrative programs Pain for a fee of $4000-$6000. Patient Care Conferences are available where all practitioners and the patient meet for a fee of $650-, there is some rebate from insurance but minimal. The demand for these services is not so high due to the cost. No
Services: primary care, acupuncture, naturopathy, chiropractic, feldenkrais, and a range of special programs are run from time to time such Pain Rehabilitation, Mindfulness-based stress reduction, Sleep Health.
Osher Centre Consultative integrative care University affiliated (UCSF) Physicians: 2 IM family physicians, 2 integrative oncologists, 1 manual medicine physician, 2 integrative paediatricians, 1 integrative psychiatrist, one women’s health naturopath The Osher centre runs an integrative clinic on a consultation basis. Integration is informal and physician led. The clinic is currently in the process of moving to electronic medical records (EMR) and it is thought this will make integration easier with shared charts. The care of a patient with a chronic condition might be led by either a physician or non-physician. The lead physician documents a treatment plan that might involve going to other practitioners for treatment and returning for a review in a set period of time. The practitioner works out a specific treatment plan but does not always communicate this back to the lead physician except perhaps incidentally. Patient review and progress is monitored by the lead physician. Case conferences are mandatory but only a limited number of cases are presented. Yes
CM staff are P/T & F/T salaried Non-physicians: 2–3 acupuncturists, 2 massage therapist, 1 biofeedback therapist, 1 integrative psychotherapist
Services and classes: guided imagery, laughter yoga classes, tai chi, yoga
Scripps Centre for Integrative Medicine Consultant care, Part of Scripps Health (not for profit); P/T & F/T CM staff are fee for service Practitioners: IM physicians in cardiac care, pain, and headache. Biofeedback practitioner, massage therapist, dietician The Scripps Centre for Integrative Medicine runs on a consultation basis. Referral is by self or specialist. Lead practitioner is typically an MD. A treatment plan may involve a dietician’s consultation, supplements (prescribed by MD), a mind-body method and perhaps biofeedback sessions. Yes, some.
Services and classes: consultant care, acupuncture, medical hypnosis, biofeedback, massage, stress reduction programs for pain or other problems, lifestyle change program, fitness centre.
Susan Samueli Centre (California) Consultant care, University affiliated (UCI School of Medicine) P/T & F/T CM staff are fee for service An IM physician, naturopath, acupuncturist and massage therapist. IM physician oversees and directs treatment, integration is informal. The overall treatment plan is coordinated with each involved practitioner and treatment is constructed according to the individual presentation and patient preference. Shared paper based records. Providers are paid based on hours spent in the clinic seeing patients. Some
University of Maryland Centre for Integrative Medicine Consultant care University based; P/T & F/T CM staff are salaried Practitioners: IM physicians, Osteopaths, Acupuncturists, Chinese medicine practitioners, Psychologist, Qi Gong and Tai Chi instructors, Reflexologist and Reiki practitioner, massage therapist. Referrals from other practitioners or self-referral to any practitioner. Initially ran integrative programs, now operates with an IHC team but joint meetings are infrequent and shared case management not common. The Clinic is in the process of moving toward shared electronic health records. Consultants work within the clinic. Providers are paid based on hours spent in the clinic seeing patients. Consultation/Collaboration? Yes
Services: consultant care, acupuncture, psychotherapy, homeopathy, reflexology, life coaching, qi gong, tai chi, nutrition.
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