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INTEGRATIVE COMPLEMENTARY CARE MISSION
| Over the past four years, the National Institutes of Health,
Medtronic Foundation, and additional private support for core
infrastructure has been used to develop a proposal to create
a reproducible model of integrative, relationship-centered care
within an academic medical center. This type of reproducible
model will allow Division faculty members to study the safety
and efficacy of complementary and integrative medical therapies
in the most effective manner. The model devised differs from
models that have been launched elsewhere in the United States
in several ways: |
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1. |
This integrative care clinical center will
be functionally integrated within a conventional health
care delivery system rather than developed as a parallel
structure or in isolation. |
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2. |
This integrative care center will start with a particular
clinical focus as opposed to offering treatment to patients
with all conditions. Since 75% of complementary and integrative
care is used for the treatment and management of musculoskeletal
pain-related conditions the center will focus on therapies
in that area, and will aim to demonstrate both clinical
efficacy and cost-effectiveness in selected patient populations. |
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3. |
This integrative care center will have a clinical team
composed of conventionally-trained physicians and “ancillary”
providers and licensed complementary care providers. The
team will include a rheumatologist, orthopedist, neurologist,
internist, nurse practitioner, occupational health RN,
psychiatrist (with expertise in mind-body therapies),
exercise physiologist, physical therapist, nutritionist,
pharmacist, chiropractor, acupuncturist, and massage therapist.
The MD members of the team will maintain their current
organizational relationships and serve as “ambassadors”
for the center. They will spend roughly half of their
time in the center and half with their respective academic
divisions/departments. This will place them in positions
to “bear witness” to successes and failures
and serve as “change agents” within the medical
center. |
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4. |
This integrative care center will have a unique electronic
medical record which will capture relevant clinical and
financial data. The technology staff at an HMS-affiliated
health center have worked with us to identify the functionality
of such a system and the possible corporate partners with
whom to develop it. |
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5. |
This integrative care center will make a concerted effort
to expand third party reimbursement through the demonstration
of the economic value of complementary and integrative
therapies and subsequent negotiations with insurers. The
Division has received NIH funding for a pilot randomized
trial to assess the cost-effectiveness of our proposed
model. |
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6. |
This integrative care center (ICC) will provide novel
educational programs including one being developed for
the initial team of providers so that they can learn how
to work together most successfully. In addition, the center
will serve as a clinical training site for our NIH-supported
fellows in complementary and integrative medicine. |
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7. |
In conjunction with complementary providers and CRICO
(Harvard’s Malpractice Insurer), this integrative
care center is formally developing policies and procedures
regarding credentialing of complementary care providers,
minimization of malpractice liability risk exposure, and
specific clinical scopes of practice for individual practitioners.
Criteria whereby pharmacy and therapeutics committees
can recommend, tolerate or proscribe selected herbs, vitamins
and supplements are also being developed. |
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Our vision is to facilitate the eventual development
of several different but related integrative care centers
across Harvard Medical School affiliated institutions that
are tied together through agreed upon policies and procedures
for credentialing and supervision of complementary providers,
malpractice liability risk reduction, pharmacy and therapeutics
recommendations, and clinical and business operations. The
information technology systems being developed for this project
will be used to create a data warehouse. In addition, each
of these clinical centers will serve as sites of coordinated
clinical research conducted by the many Harvard Medical School
faculty members who have indicated a willingness and desire
to work with the Division. Our current work focuses on the
implementation of the first reproducible integrative care
clinical center at one of Harvard’s affiliated hospitals.
The Division’s leadership believes that
integrative care embodies the best of conventional medicine
as well as evidenced-based complementary therapies. This reinforces
the commitment to shared decision-making, patient autonomy,
and patient participation. It is also open to the judicious
use – or avoidance – of complementary therapies
based on critical evaluation of commonly-used interventions.
Patients want both and, ideally, they want guidance on when
and how to access complementary therapies under the supervision
of their conventional physicians. Developing a reproducible
model of clinical care that incorporates elements of mind-body
and complementary medicine and delivers these through evidence-based,
compassionate, humane care models in an academic medical center
affords a great opportunity to inform and refine our existing
medical delivery system.
The training of the interdisciplinary team will be guided
by core values including: a heightened appreciation of shared
decision-making; an appreciation for self care on the part
of patients and providers; a participatory model in which
patients must actively participate in their treatment and
maintenance of wellbeing; incorporation of fundamental tools
of mind-body wellness; and an exploration of the maximization
of the therapeutic alliance. For example, one hypothesis is
that as long as a patient has an extremely supportive therapeutic
alliance with at least one member of the health care team,
there may be a reduction of time spent by the other members
of the health care team so as to deliver a more efficient
and effective treatment regimen. This is a testable hypothesis
that will be incorporated into the first clinical trial.
As required by the NIH, this development project
involves a medical anthropologist, Bonnie O’Connor,
PhD, whose task is to interview the providers, the patients,
the administrators, and the allied health personnel associated
with this experiment. This is being done in an effort to document
the inter- and intra-professional challenges that arise in
our efforts to develop a relationship-centered, trans-professional,
integrative care model. Again, the hypothesis is that obstacles
identified in this trial will arise in any group attempting
to develop a similar model of patient-centered care anywhere
in the United States.
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