Good Samaritan Hospital & Emperors Look at Cost Benefits of Inpatient Acupuncture
Written by John Weeks
Good Samaritan Hospital and Emperors College Engage Cost/Care Project Looking at Broad, Trusting, Inpatient Look at Well-Integrated Acupuncture
Summary: Well-integrated acupuncture, as provided by licensed acupuncturists, is finally getting a test in inpatient care in a US hospital. Through relationships built between Los Angeles' Good Samaritan Hospital (GSH) and Emperors College of Traditional Oriental Medicine, Jeannette Painovich, LAc, DAOM will soon be managing a $218,500 research project. LAcs will practice side-by-side with conventional MDs and nurses in treating a whole array of critical conditions. Clinical, patient satisfaction and cost outcomes will be measured, with a particular focus on potential savings in the area of length of stay. A key element in the set-up is the acupuncture profession's new Doctor of Acupuncture and Oriental Medicine (DAOM) clinical doctorate, through which GSH will have its acupuncture clinicians. The project has more potential for impact on US health care than any dozen acupuncture RCTs.
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Jeannette Painovich, LAc, DAOM
Jeannette Painovich, LAc, DAOM, is blunt about the premise behind a new $218,500 inpatient acupuncture project which she will manage: "I believe that if acupuncture is used as it is supposed to be used, we will positively impact the cost of hospital care."
Painovich clarifies that the project she will be directing is not a typical, limited, acupuncture-for-one-condition randomized controlled trial: "This is not a protocol study of acupuncture but a study that allows acupuncturists to practice their best medicine side-by-side and integrated with conventional care." Then Painovich states a belief likely held by a majority of licensed acupuncturists: "I believe we will see cost benefits from shorter length of stay and diminished use of pharmaceuticals."
Through a $218,500 grant to Los Angeles' Good Samaritan Hospital (GSH), Painovich and her colleagues will have a chance to test this belief. A health-related foundation granted the nearly a quarter-million dollars of funding to create the "Inpatient Acupuncture Implementation and Assessment Program" at Good Samaritan Hospital. The pilot program will last 24 months. A Grant Built on Layers of Trust
The grant followed two years of acupuncture practice engaged through an inter-institutional relationship between Emperors College of Traditional Oriental Medicine and GSH. Through the "Acupuncture Residency Program," licensed acupuncturists who are students in the Emperors' Doctor of Acupuncture and Oriental Medicine (DAOM) program have provided care through GSH's Acute Rehabilitation Unit. Painovich has been the lead acupuncturist in that project. Taking the lead in study design and methodology is Patricia Hermann, ND, MS, a statistician/methodologist who has been associated with the Program in Integrative Medicine at the University of Arizona.Two sets of controls will be used. (See chart.)
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Good Samaritan Acupuncture Program at a Glance
Location
Good Samaritan Hospital (GSH), Los Angeles
Mainstream Academic Affiliations
GSH is affiliated with the USC Keck
School of Medicine
CAM academic affiliation
DAOM program, Emperors College of Traditional
Chinese Medicine
Total grant
$218,500
Duration
24 months, including 20 months of treatment
Leadership team
Jeannette Painovich, DAOM, project director
Patricia Hermann, ND, MS, study design
Ron Greeno, MD, study manager
Jorge Minor, MD, care integration
Number of patients to be treated
600 in-patients; 6-8 per day during the study
Treatment frequency
Daily or near-daily
Total anticipated treatments
2,000
Diagnoses
Various - congestive heart failure, pneumonia,
stroke, coronary artery bypass, asthma,
chronic obstructive pulmonary disease, hip
and knee replacement, laminectomy patients,
plus.
Clinicians
LAcs who are DAOM students at Emperor's
Referral
Treatment will be receive under MD/DO orders
as a treatment modality
Outcomes
Effectiveness, satisfaction, cost
Controls
Two groups:
1. Analysis of patients with similar conditions from
twelve months prior, same MDs.
2. Analysis of outcomes of those refusing acu.
Hospital incentive
Mission to provide quality, comprehensive care,
plus a program focus on conditions that often
have "hospital stays that exceed Medicare
funding."
Information based on data in the GSH funding proposal.
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Painovich is clear that a study focus is on helping "measure whether acupuncture helps counter the escalating
rise in healthcare expenditures." The team views the project as a pilot for the nation. The projects measurable objectives are defined as:
Lower average financial costs for
critically ill inpatients
Decreased average hospital stays
Outcomes of quality of care
surveys completed upon discharge
A pilot study providing statistics and
analysis on the effectiveness of acupuncture as an adjunct therapy
A process and outcomes evaluation report.
Painovich credits a relationship she developed with Ron Greeno, MD, a GSH pulmonologist and hospitalist, for opening doors to getting the study rolling. The other key member of the team, beyond research methodologist Hermann, is GSH's chair for interdisciplinary practices, Jorge Minor, MD. Minor will foster the deeper integration of acupuncture into the hospital services which will allow the pilot to operate and be measured.
Painovich told the Integrator that she plans to have acupuncturists who are Chinese nationals, or US-trained LAcs with similar experience, as supervisors. She's looking for extensive in-hospital experience such as the Chinese nationals receive in their home country. GSH intends a more extensive investigation if the pilot has positive outcomes. Comment: This announcement has a seasonal lift in it, the potential coming of the light on long-held assertions. Finally! Kudos to Painovich, the Good Samaritan Hospital team, Emperors College, and the foundation decision-makers. What will we find? Some thoughts:
Good for GSH and Emperors for creating the
human connection and clinical experience to break down medical bias and
get this rolling.
Potential cost benefits This study offers, even as a pilot, more potential for impacting today's healthcare than any dozen randomized controlled trials (RCTs). Want to impact health care? Follow the money - and show a positive difference.
Relationships - Personal and Inter-Institutional Note that the very possibility of the study was built on relationships. At the first line are those between individual clinicians - Painovich and Greeno in particular. But note that these are based in an existing inter-institutional relationship between GSH and Emperors. Institutional commitment created, and supports, the individual commitments. Emperors' past president, David Solin Lee, deserves a nod for moving Emperors toward both developing a DAOM program and for forging the relationship with GSH.
DAOM as a Tool for Building Relationships The program was built on the Doctor of Acupuncture and Oriental Medicine, DAOM, the licensed acupuncture profession's new clinical doctorate program. These programs, in which the students are already licensed practitioners, provide tremendous, low-cost research and clinical opportunities for conventional facilities located near them. Unfortunately, the DAOM is largely a West Coast phenomenon at this time.
Limited Scope Note also that the clinical scope of the project, despite a breadth of scope that is almost unimaginable amidst the conservatism of other hospitals, is yet a compromise. While the acupuncturist practitioners are empowered, they are not yet offering all of the whole practice potential of AOM. Traditional medicines, moxa and other physical medicine approaches are not part of the mix. While thus side-stepping the potential, adverse drug-herb interaction issues, we still won't be measuring the optimal value of TCM.
Now, when will the first hospital pro-actively integrate massage therapists, or naturopathic physicians, or holistic nurses or other mind-body providers? When will we have a chance to look at these other practitioners' potential impacts on health, costs, and satisfaction? Haven't we got a cost crisis here that suggests getting out of our clinical and institutional boxes?
Apparently we still lack the trust, and relationships, to make good on these other potential bountiful explorations. Good for GSH and Emperors for creating the human connection and clinical experience to break down medical bias and get this rolling.
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The grant followed two years of acupuncture practice engaged through an inter-institutional relationship between 
Painovich credits a relationship she developed with Ron Greeno, MD, a GSH pulmonologist and hospitalist, for opening doors to getting the study rolling. The other key member of the team, beyond research methodologist Hermann, is GSH's chair for interdisciplinary practices, Jorge Minor, MD. Minor will foster the deeper integration of acupuncture into the hospital services which will allow the pilot to operate and be measured. 
