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Based on estimates from points on a line-graph in a powerpoint.
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The Rationale for Health Services Research: Institute of Medicine and NCCAM Recommendations Nahin's presentation at the advisory council began with some elementary education. The concept paper is formally focused on "Outcomes, Cost-effectiveness, and the Decision Process to use CAM." All areas represent targets of "health services research" (HSR). Nahin offered the definition of HSR used by the US Agency for Healthcare Research and Quality (AHRQ): "Health services research (HSR) examines how people get access to health care, how much care costs, and what happens to patients as a result of this care.”  While the AHRQ is the federal agency with core responsibilities in this area, HSR is one of 10 domains which NCCAM has identified as important in its strategic plan. Nahin notes that HSR approaches can be useful for numerous reasons. HSR approaches can:
Another major area of potential value is cost of treatment. Nahin notes that HSR approaches are the best way to see the impact of CAM use on costs. Do complementary interventions add to the costs of conventional care? Or do they replace or lower them? What is the cost of combined CAM plus conventional versus either alone? Nahin notes that the 2005 report from the Institute of Medicine on CAM in the United States specifically recommends that HSR be engaged. The IOM urged studies which ask: "Are models of integrative medicine cost-effective when compared with the cost of care obtained in conventional medical practice settings?"Nahin noted that IOM's HSR-related recommendations also focused on exploring why consumers and practitioners choose to use CAM.
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Total Health Services Research* as a Part of NCCAM Budget
(R01 and R21 Grants)
% is based on estimates from points on a line-graph in a powerpoint.
* Other forms of HSR included, besides cost and outcomes noted above, are examinations of those who use the services and exploration of why they use the services.
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Overcoming a Neglectful Legacy In his slide show, Nahin rhetorically asked: "So what is NCCAM's commitment to HSR?" All health services research was at its peak in 2002 with 11 projects. This represented roughly 2.75% of NCCAM's budget. Four years later there were just 5 projects funded, representing 1.55% of the NCCAM budget. Yet only a fraction of these funds actually looked at effectiveness and cost-effectiveness. In 2002, funds for these tow types of explorations totaled 1.1% of NCCAM funds, a portion which dropped to an even more miserly 0.64% just 4 years later.
Making Amends: "Encourage research in actual healthcare settings" Nahin's slide show then lays out the simple rationale for the new initiative: "NCCAM is not taking advantage of scientific opportunities offered by current public use of CAM to study CAM in 'real-world' settings as outlined in NCCAM Strategic Plan and IOM Report on CAM."The new program's objectives, then, will be "to encourage research on how CAM therapies function in actual healthcare settings." The program will have "an emphasis on observational studies and secondary data analyses." Comment: I had the opportunity this past week to spend considerable time with a health services researcher with over 30 years of experience analyzing diverse state, federal, private, not-for-profit and corporate projects. I asked him, point blank - and not for attribution - why he thought it was that we have had but pennies thrown in the direction of cost and effectiveness studies, given their potential value. His response was immediate, and blunt: "It would give them credibility."
Interestingly, given my colleague's comment, the decline of resources witnessed here has come at a time when the percentage of members of the NCCAM advisory council who are from licensed disciplines has also slipped significantly. As noted in a prior Integrator article, the Congressional mandate which established NCCAM calls for at least 50% to be licensed members of the disciplines NCCAM is charged to evaluate. This was the council's make-up in 2002. However, the present council has drawn only 28% of its members from the licensed disciplines. These are the very disciplines which operate in the real world by drawing consumers into their practices. These are the professions most likely to have a chance to gain credibility through an aggressive HSR agenda. I only note this association. It is possible that the parallel decline in licensed members of the advisory council and in studies that might quickly earn their practices credibility is no more than a coincidence. Whatever the past, the present program which Nahin introduced for NCCAM on September 5, 2007, is an opening into a more useful research future for NCCAM. And with this program, the question now becomes a kind of put-up or shut-up: Do natural health care disciplines and integrative medicine practices and businesses have the focus, the self-confidence and wherewithal to seize this opportunity to gain recognized as the effective and cost-effective interventions they believe they represent?
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