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Chrysler Expands Group-Focused Integrative Pain Partnership with Henry Ford Health System CAM Group PDF Print E-mail
Written by John Weeks   
Monday, 23 July 2007

Group-Focused Integrative Pain Program for Chrysler Employees Better than CAM or PT in Henry Ford Health System Pilots

Summary:  Preliminary data from two pilots projects from the Henry Ford Health Systems (HFHS) on chronic low back pain, one involving Chrysler employees, showed significant findings. One showed that one-on-one care involving chiropractors, acupuncturists, neuromuscular therapists, hypnotherapists, massage therapists and somatic education practitioners performed better than a typical physical therapy protocol. The second, a group intervention using complementary healthcare approaches, topped the other outcomes.  The group intervention succeeded in resolving pain to zero in over 50% of the Chrysler employee participants. Chrysler has asked the program designer, HFHS's research director for complementary and integrative medicine Robert A, Levine, PhD, to start up 4 new groups this fall. When will complementary healthcare disciplines begin exploring the powerful potential for group-focused services?
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Robert Levine, PhD, directs complementary and integrative medicine research for the Henry Ford Health System (HFHS). Levine is a research pharmacologist with a specialty in brain function whose personal health issues moved him personally and professionally
Image
Robet Levine, PhD, Henry Ford Health System's integrative research leader
toward natural healthcare strategies 15 years ago. He recently completed two intriguing integrative healthcare pilots involving chronic back pain, each with the same inclusion criteria. One involved employees of the Chrysler Corporation.

That Levine and HFHS had Chrysler involved in one of the studies makes outcomes particularly interesting. The pilot's yardstick is not just statistical data. It is also Chrysler's real-world buy-or-not-to-buy decision. Will the employer embrace and expand any part of the program? Levine put Chrysler's response to the low back pilot this way: "They said that if Toyota had their hands on the work of our team, they wouldn't let us go. We are in discussion to set up four programs this fall with two of them expanding to look at a range of chronic diseases."

Group-focused program tops one-on-one services, CAM or conventional

Levine's 2 pilots allowed the comparison of three one-on-one strategies (conventional physical therapy, plus two strategies with different mixes of complementary healthcare practitioners) and a group intervention, using natural healing approaches, with Chrysler employees. Interestingly, Chrysler's excitement, and desire for expansion, was particularly related to the outcomes of the more unusual treatment - the group treatment - which is also significantly less expensive. In that group, services were delivered by a practitioner team led by Levine to patients in a group setting, instead of individual practitioners in a one-to-one setting.
_______________________________

Henry Ford/Chrysler Integrative Therapies Low Back Pain Pilot
Preliminary Health Outcomes Comparisons of the "We've Got Your Back" Program

 Model
 

 Therapies
  (#) and %
with pain
resolved
to "0"


Conventional
physical therapy


 
As practiced by
PTs in HFHS

one-on-one setting

   5%
 
Comprehensive
CAM

 
Mix of chiropractic,
acupuncture and
neuromuscular
movement,
mind-body, plus

one-on-one setting

  16%
 
Streamlined
CAM

 
Massage therapist
delivered non-
needling acu-point
stimulation,
mind-body therapy,
plus somatic
movement
re-education

one-on-one setting

  25% 
Chrysler group
intervention
 
Guided relaxation
plus somatic
movement
re-education
 
group setting

 
55%


Source: Robert A. Levine, PhD, Certified Hynotherapist, Henry Ford Health System.
_________________________________

Findings of hands-on and hands-off interventions

Levine notes that all of the interventions were better at bringing participants to zero pain than was typical treatment by physical therapists within the Henry Ford system. The "comprehensive CAM approach" had each patient receiving a combination of treatments involving 34 contact hours, using a "fixed protocol," according to Levine. Interestingly, the less intensive, "streamlined" complementary healthcare approach, involving just 24 contact hours, without needles or chiropractic care, scored better.

Image But like Chrysler, Levine is particularly intrigued with the group outcomes. Said Levine: "
The Chrysler group intervention was more effective than any of the 1-on-1 treatment strategies and 10 times more effective than conventional PT!"  Levine suggests positive cost benefits - both as measured in employee hours in time in treatment and practitioner hours: "For me to treat the Chrysler employees one-on-one would take more than a year. In group, they were treated in 24 contact hours. The group approach allows for much more patient throughput."

In this case, the group treatment was more successful: 55% of Chrysler employee participant reported that their chronic low back pain was at 0 after the treatment program. And the icing, to Levine, was that the Chrysler employees also saw significant benefits in the areas of depression, stress, sleeplessness, and resolution of other health issues nominally unrelated to back pain.

Levine co-delivered the group program with Ramon Nunez, a doctor of Oriental medicine who is "masterful at movement re-education" according to Levine. Levine's own part was to deliver what he calls "guided relaxation for new awareness."  In an internal memo shared with the Integrator, Levine writes: "We have achieved these results with a hands-off group intervention that has patients taking responsibility for getting themselves out of pain."

Image Chrysler in discussion for 4 new groups

Levine presented preliminary findings as a poster at the Integrative Medicine for Health Care Organizations conference in April 2007 in San Diego. He is now seeking to find the time to write them up, but he has some competition for his time from his corporate partner. Why? Chrysler is exploring with Levine setting up 4 new groups starting this fall.

Levine reveals that 2 of the potential groups will again focus on chronic back pain. But it is the other two which particularly intrigue Levine: "We would like to start two groups which focus on chronic illness. We would like to have people with cardiovascular disease, diabetes, obesity and gastrointestinal disorders all together in group." Levine believes that there are enough common denominators between individuals with each of these conditions that a program targeting chronic conditions will prove beneficial.

Contact: Levine can be reached at
   
  On the Chrysler
Group Intervention:

"We have achieved
these results with a
hands-off group
intervention that has
patients taking
responsibility for
getting themselves
out of pain."

-Robert A. Levine




Comment
Question: What do the work of integrative health care pioneers like Jon Kabat-Zinn, PhD, Dean Ornish, MD and Herbert Benson, MD and Eileen Stuart, PhD, RN have in common?

Answer
: Each has provided evidence of the effectiveness of natural healthcare protocols for serious conditions - and each has done so through whole-person oriented natural healthcare protocols delivered principally to groups instead of one-to-one.

Levine's group work with Chrysler falls squarely into these camps. One looks forward to a full, scientific write up to explore the many questions regarding the structure of care delivery and the outcomes measures.

Yet what the work underscores is that the power of the group environment - while only piloted here - has proved to be profound. It is perhaps the most under-explored area for healthcare delivery of any kind. Such an approach is particularly under-explored among the complementary, alternative and integrative healthcare disciplines for which such natural and patient empowering approaches are wholly aligned.

Why the lack of exploration? All disciplines, conventional and complementary, have in common a self-interest in perpetuating the one-to-one service delivery method they were schooled to practice. 

In fact, complementary healthcare practitioners who don't like this assertion may have just experienced an insight into the recoiling conventionally-trained medical doctors often feel when confronted with holistic care models. You mean all those years are for nothing and I have to change what I do? An exception in the natural healthcare practitioner community is the Community Acupuncture Network model in which care is delivered in open rooms and patients speak of the healing value of being in a group environment.

I look forward to the next stage findings for the Chrysler experience - applying the group model to participants with diverse chronic conditions. Meantime, all educators and practitioners who practice healthcare would be served to deeply consider these outcomes. Incorporating ways for any provider type to work in their practices efficiently, as educators, should be part of fundamental healthcare reform. Those disciplines which engage this practice-shifting learning may have a leg up on others - at least in the mind of a discerning employer.

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for inclusion in a future Your Comments article.

Last Updated ( Wednesday, 25 July 2007 )
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