Details on Hospital Inclusion of CAM - A New Health Forum-AHA Report

Summary: In a report released July 18, Health Forum, a for-profit affiliate of the American Hospital Association, reveals that the percentage of respondent hospitals offering at least some CAM services, whether to patients or employees or both, has grown to 26.5% from single digits over the last seven years. The survey findings, developed under the leadership of Sita Ananth, MHA, provide a snapshot of the extent, motivation and structure of the uptake of CAM services into the tertiary care, economic center of US health care

indicate that 370 are integrating some CAM services into their operations.  And for more than half, the reasons are not just patient demand. They are also linked to a deeper mission (62%) and perception of clinical effectiveness (61%).

Sitas Ananth, MHA

Since 1999, the AHA has asked a question regarding CAM in its Annual Survey of Hospitals. The hospitals responding "yes" have crept steadily up from from 7.7% to 18.3% in 2004. But what does this mean? What are they offering?

Sita Ananth, MHA, the project director for complementary and alternative medicine for the AHA and its Health Forum affiliate, led the recent project to independently survey the nation's 6347 hospitals on CAM services. The topics covered in the 32 page report include: CAM services and location, finances and reimbursement, planning and staffing, and evaluation and research.

• over 50% of hospitals with CAM programs did not have CAM in the hospital's strategic plan
• most CAM programs did not have a strategic plan in their launching
• 41% have an MD directly involved
• only 40% report even "periodically" to their hospital boards.
  

Report Purchasing and 2007 Health Forum IM Conference: The report, plus a companion detailed breakdown, is available through calling 800-242-2626 or through clicking on  this AHA link. Health Forum has also announced that the 5th Annual Integrative Medicine for Healthcare Organizations Conference will be held on April 12-14, 2007, in San Diego. To explore exhibiting, sponsorship or to be on the mailing list, please contact Sita Ananth at or 707-644-1181.

Comment:  Credit Sita Ananth's long-time work with Health Forum and AHA for bringing this useful snapshot forward, and for continuing with the annual Health Forum Conference. These are both key elements in the broader CAM-IM integration effort. The jump from 7.7% of hospitals having some CAM, in 1999, to apparently 26.5% in this survey, suggests significant movement. Credit, as well, the pioneering administrators and practitioners who have engaged these integration processes.

However, I find myself following a more sober analysis. My assumption is that those programs with CAM are most likely to have responded to this survey. This could significantly skew any extrapolation from the data. Let's then imagine worst case - that all of the hospitals with CAM responded. What we would know for certain is that 370 of 6347 hospitals offer some form of CAM, or 5% of the 6347. Of the 6347, 2.5% would then have CAM in their strategic plan. Of the 6347, 1/2 of 1% would be offering acupuncture in inpatient care. Chiropractic, naturopathy and homeopathy don't even show up (though they were on the survey form).

So, then, somewhere between the happier extrapolations of the study, and this negative view, is where we are, 13 years after the Eisenberg study in the New England Journal of Medicine hit the hospital universe with news that over a third of adult Americans are using CAM, and 10 years after the NIH Consensus Conference on Acupuncture. One global reading on this snapshot is that we may, yet, only barely be integrating these services into the care we deliver in the economic engine of US medicine.

So what conditions might hasten the uptake on CAM in hospitals? Milt Hammerly, MD, quoted in the report, notes in an IBN&R interview that some involved with the 100,000 Lives Campaign of the Institute  for Health Improvement (IHI) are pushing IHI and its leader Donald Berwick, MD, to take up the banner of patient-centered/person-centered care. If this guiding edge of hospital reform strongly linked to person-centered care in its annual meeting this fall, the presence of CAM-IM and mind-body approaches in US hospitals may finally be anchored to core hospital mission. States Hammerly:

"If we are genuinely interested in delivering person-centered care we must understand how to rationally integrate the use of CAM therapies in a safe, timely, effective, efficient and equitable manner. Let's not kid ourselves with thinking that we can be person-centered if we ignore what's important to a large number of our patients."  (Health Forum/AHA, 2006, page 5.)