Integrative Medicine in Hospitals
and Academic Institutions
Dr. Ather Ali, ND, MPH, MHS (c)
Associate Research Scientist, Department of Pediatrics
Integrative Medicine Specialist, Yale Stress Center
Director, Integrative Medicine at Yale
Atatürk Üniversitesi
May 2014
SLIDE 0
Outline
• Considerations
• Consortium of Academic Health Centers for Integrative Medicine
• Models of Integrative Medicine
– Yale Stress Center
– Integrative Medicine Center at Griffin Hospital
• Best Practices
• Resources for information
SLIDE 1
Considerations
• Academic Health Centers and Teaching Hospitals
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High credibility
Seen as highest quality care
Mission to educate and train
Innovators in methods
Discovery and application of knowledge
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Integrative Medicine and U.S. Academic Medicine
• < 20 year-old movement
• Consortium of Academic Health Centers for Integrative Medicine
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Started with 8 universities + Deans (2000)
Now – 57 Medical Schools (140 total)
National and global influence
Working groups focusing on
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Research
Clinical care
Education
Policy
– International Congress on Integrative Medicine and Health (IRCIMH)
• Every 2 years
• Miami, Florida (USA) – May 2014
• Partners with International Society for Complementary Medicine Research
(ISCMR)
SLIDE 3
International Research Congress on Integrative
Medicine and Health – May 2014
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CAHCIM
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“Our mission is to help transform medicine and healthcare through
rigorous scientific studies, new models of clinical care, and innovative
educational programs that integrate biomedicine, the complexity of
human beings, the intrinsic nature of healing and the rich diversity of
therapeutic systems.”
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Schools with demonstrated programs in (two of):
– research, education, or clinical care
Members include Yale, Stanford, University of California San Francisco,
UCLA, Harvard, Duke, Johns Hopkins, Mt. Sinai, Columbia, Mayo Clinic,
UWashington, University of Pennsylvania
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Models of Integrative Care (Outpatient)
• Referral-based
• One-stop-shop
– Doctor who has multiple skills
• Multispecialty integrative medicine practice
– Ataturk University example
– Yale Stress Center example
• Multidisciplinary evaluations
– Griffin Hospital example
• Inpatient care is unusual
– Inpatient consults
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Yale Stress Center
• Directed by Rajita Sinha, PhD (clinical psychologist)
• Clinical care started 2012 / Research Center since 2007
• Integrated mind-brain-body framework
– treatment and prevention of stress-related conditions
– symptom control
– primary, secondary, tertiary prevention
• First Integrative Medicine clinic at Yale
• 400- 500 patients / month
• Clinical training
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Predoctoral and postdoctoral psychology fellows
Medical residents
Undergraduate students
CAM students
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Yale Stress Center – clinicians
• Clinical Psychologists (PhD or PsyD)
• Psychiatrist (MD PhD)
• Naturopathic Physician / Integrative Medicine Specialist (ND
MPH)
• Yoga and Mindfulness Instructor (MA RYT)
• Licensed Drug and Alcohol Counselor
• Endocrinologist (Adult and Child) (MD PhD)
• Licensed Professional Counselor (LPC)
• Clinical Psychologist /Acupuncturist (PsyD)
• Registered Dietitian /Certified Diabetes Educator (RD CDE)
• Exercise Physiologist (PhD)
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Yale Stress Center – services
• Extensive stress evaluation and diagnostic assessment
– Biochemical analysis for stress, health and immune functioning
• Stress reduction workshops
• Mindfulness-based stress reduction, guided breathing, and
relaxation training
• Personalized life coaching
• Integrative Medicine evaluations
• Dietary supplement evaluations
• Weight loss programs (individual and group)
• Acupuncture
• Exercise coaching
• Individual and group psychotherapy
• Psychopharmacology
SLIDE 9
Yale Stress Center - Financial
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Commercial insurance
Medicare/Medicaid (government national and state programs)
Yale Health Plan (for Yale University employees)
Practice of the Yale Medical Group
– a multi-specialty academic group practice of full-time faculty at the
Yale School of Medicine
• Portion of revenue goes to Medical School
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Integrative Medicine Center at Griffin Hospital
• Yale-affiliated community hospital
• “Evidence-based integrative care”
• Uses a novel MD-ND model of care
– Dual evaluations with internal medicine doctor
and naturopathic doctor
• Focus on health and wholeness
• Least invasive therapies when possible
• Also predicated upon:
– The belief that no one person can know it all
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Goals and Ideals
• There is no “alternative” vs. conventional care
• There is a single spectrum of options for care and healing,
encompassing all
• The spectrum of healing arts is subject to the same evidence
hierarchy, and creatively applied research
• Patients are guided/accompanied to the best, tailored options
Katz D, Ali A. Preventive Medicine, Integrative Medicine, and the Health of the Public. Commissioned paper for Institute of Medicine (IOM) of the
National Academies .2009.
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Examples of therapies
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CAHCIM Survey Data - Best Practices
• Built relationships with other departments
– pain, cancer, rheumatology, cardiology
• Became part of the medical center through education
– teach medical school electives and classes
– supervise practicums, residents and fellows
– speak at grand rounds
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Best Practices – CAHCIM Survey
• Clinical services (most profitable): chiropractic/manual medicine,
acupuncture (especially community model), and integrative mental
health
• Philanthropy
• Group Classes
• External: Partnerships resulting in diversity, outreach, and
innovation
• Internal: Collaboration and case conferences
• Metrics
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Demonstrate economic impact to Academic Health Center
Patient satisfaction, return on investment
demonstrate efficiency/effectiveness
helps decision-making
MacElhern L. CAHCIM Survey 2013.
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Experiences of successful centers
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Work with integrative health experts
Start small and grow
Collaborate with non-faculty providers
Network heavily on campus and in the community with “friends”
who could be referral sources
Choose modalities that are evidence-based, readily acceptable, and
build trust
Use electronic medical record to share
Conferences / retreats / workshops
Many have mindfulness meditation programs
– MBSR Research
• (Influential) Faculty Champion
Vanderbilt Center for Integrative Health
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Financial Considerations
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48% - Philanthropy/donations
21% - Other
18% - Grants
13% - Academic Health Center
MacElhern L. CAHCIM Survey 2013.
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What not to do
• Fall prey to the “guillotine effect”
– Keep people in different centers/departments
• No distinct identity from academic health center
• Having only one area of expertise
– Trying to have expertise in too many areas
• Be content / complacent with current successes
MacElhern L. CAHCIM Survey 2013.
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Recommendations: Outcomes Research
• Systematic data capture and analysis
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To measure population health
To predict health outcomes
To address demands for accountability
To improve the knowledge base of a practice or procedure
To evaluate treatment intervention effectiveness
To improve quality
To market a practice, service or procedure
Kemper K / Kane, R.L. and Radosevich, D.M. (2011). Conducting health outcomes research.
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Outcomes Research in IM: Understand philosophy
Kemper K. IRCIMH 2014.
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Resources
• Bravewell Collaborative Reports
– Integrative Medicine in America
– Integrative Medicine: Improving Health Care for Patients and Health
Care Delivery for Providers and Payors
– The Efficacy and Cost-Effectiveness of Integrative Medicine
– Best Practices in Integrative Medicine: A Report from the Bravewell
Clinical Network
• The Integrator Blog
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This work was supported by a grant from
National Center for Complementary and Alternative Medicine
National Institutes of Health
U.S. Department of Health and Human Services
www.nccam.nih.gov
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