Details on Hospital Inclusion of CAM - A New Health Forum-AHA Report
Written by John Weeks
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
Consumer interest continues to drive the interest of US hospitals in
offering complementary and alternative medicine (CAM) services. And these consumers are still paying for this care,
out of their own pockets. But the responses of 1394 hospitals to a recently
released Health Forum-American Hospital Association (AHA) Complementary and Alternative Medicine Survey of Hospitals 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.
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Hospital Inclusion of CAM: At a Glance
From the Health Forum 2005 Complementary
and Alternative Medicine Survey of Hospitals
Some of the more interesting survey
outcomes related to the role of the programs within the greater hopital
system. For instance:
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.
However, a surprisingly high percentage (49%) report "good" to "excellent" levels of referrals from medical staff.
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.)