Use and Effectiveness of a Model Integrative Care Clinic in an Academic Hospital

学术医院示范综合护理诊所的使用和有效性

• 批准号: 8722444
• 负责人: Julie E. Buring
• 金额: $ 62.11万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2017-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8722444
• 关键词: Academic Medical Centers; Address; Ambulatory Care; Attitude; Back Pain; Behavior; Belief; Boston; Caring; Chronic; Chronic low back pain; Clinic; Clinical; Cohort Studies; Communication; Communication Barriers; Complement; Complementary and alternative medicine; Data; Decision Making; Diagnostic tests; Effectiveness; Environment; Ethnography; Evaluation; Evolution; Feeling; Foundations; Funding; Future; Goals; Growth; Health; Hospitalization; Hospitals; Individual; Intervention; Interview; Knowledge; Lead; Medical; Medical center; Modality; Modeling; National Center for Complementary and Alternative Medicine; Observational Study; Outcome; Outpatients; Pain management; Patient Self-Report; Patients; Pattern; Persons; Pharmaceutical Preparations; Physicians; Pilot Projects; Population; Procedures; Process; Productivity; Provider; Quality of life; Randomized Clinical Trials; Randomized Controlled Trials; Reporting; Research; Research Design; Safety; Source; Structure; Surgical Management; Surveys; Symptoms; System; Teaching Hospitals; Telephone; Therapeutic; Time; Training; United States; Use Effectiveness; Visit; Woman; Work; Workplace; base; care delivery; clinical care; clinical decision-making; cohort; comparison group; conventional therapy; cost; cost effectiveness; design; disability; efficacy evaluation; expectation; falls; functional status; health care service utilization; health related quality of life; improved; instrument; medical schools; meetings; member; multidisciplinary; patient oriented; programs; prospective; public health relevance; response; satisfaction; sociologist; treatment as usual; treatment duration

DESCRIPTION (provided by applicant): Despite widespread use of complementary and alternative medicine (CAM) in the US, there exist significant gaps in our knowledge regarding CAM decision-making, efficacy, safety and cost-effectiveness. Several factors contribute to this gap, including: limited communication between patients, conventional care providers, and CAM providers, about CAM use and therapies recommended; the focus on evaluation of efficacy and safety of individual CAM therapies or interventions, making it difficult to extrapolate these results to patterns of real-world multi-modality CAM use in conjunction with conventional therapy; and the limited pragmatic research conducted within existing integrative care centers. With funding support from NCCAM, the Osher Clinical Center (OCC) for Complementary and Integrative Medical Therapies was established in 2007, physically located in the Ambulatory Care Center of Brigham and Women's Hospital (BWH). This recent opening provides a unique window of opportunity to accomplish two aims: To characterize the early evolution of referral and practice patterns and to evaluate various aspects of communication and decision-making surrounding the use of conventional and CAM therapies in real world settings; and to provide important observational evidence concerning the effectiveness of an integrative care team with respect to relevant clinical outcomes for a serious and disabling condition, chronic low back pain (CLBP). The first aim will be assessed from four different perspectives: surveys of new patients to the OCC; surveys of BWH physicians who have referred their patients to the OCC; surveys of physicians at BWH in the same departments as the referring physicians but who have not referred to the OCC at two time points; and in- depth qualitative interviews of dyads of referred patients and their referring physicians. The second aim will be addressed in a prospective, observational cohort study, following 150 OCC patients with CLBP and a comparison group of 150 BWH non-OCC CLBP patients with regard to symptom relief, functional status, satisfaction with care, quality of life, utilization of medical care, and productivity. Qualitative interviews of both CLBP patients, as well as members of the OCC team, will be conducted to characterize the course of patient treatment, both from the perspective of the patients as well as the providers. Results of our patient and physician surveys will provide assessments of knowledge, beliefs, referrals, levels of communication, and barriers and facilitators of CAM use in a hospital setting of an academic medical center, and will track these behaviors over time. Results of our observational study will be used to inform and design a future randomized clinical trial evaluating the efficacy and cost-effectiveness of a model of integrative care for the treatment of CLBP.

描述（由申请人提供）：尽管在美国广泛使用了补充和替代医学（CAM），但我们的知识方面存在很大的差距，这些差距关于CAM决策，效力，安全性和成本效益。有几个因素导致了这一差距，包括：有关CAM使用和建议的疗法，患者，常规护理提供者和CAM提供者之间的沟通有限；重点是评估单个CAM疗法或干预措施的功效和安全性，因此很难将这些结果推断为现实世界中多模式CAM的模式，并与常规疗法结合使用；以及在现有综合护理中心内进行的有限务实研究。 在NCCAM的资金支持下，Osher临床中心（OCC）用于互补和综合医疗疗法，于2007年建立，物理位于杨百翰和妇女医院（BWH）的门诊护理中心。最近的开放提供了一个独特的机会来实现两个目标：表征转介和实践模式的早期演变，并评估围绕现实世界中常规和CAM疗法使用的沟通和决策的各个方面；并提供有关综合护理团队在相关临床结果方面的有效性的重要观察证据，以实现严重和残疾状况，慢性腰痛（CLBP）。 第一个目标将从四个不同的角度进行评估：对OCC的新患者的调查；将其患者转介给OCC的BWH医生的调查；与推荐医生在同一部门对BWH的医生进行调查，但在两个时间点没有提及OCC；以及参考患者及其参考医师的二元组的深度定性访谈。第二个目标将在一项前瞻性观察队列研究中解决，此后150名OCC患有CLBP的患者和150个BWH非OCC CLBP患者的比较组，以减轻症状，功能状况，对护理的满意度，生活质量，医疗保健利用和生产力。从患者和提供者的角度来看，CLBP患者以及OCC团队的成员的定性访谈以及OCC团队的成员都将进行表征。 我们的患者和医师调查的结果将评估知识，信念，推荐，沟通水平以及在学术医学中心的医院环境中使用CAM的障碍以及促进者，并会随着时间的流逝而跟踪这些行为。我们的观察性研究结果将用于告知和设计一项未来的随机临床试验，以评估综合护理模型对CLBP治疗的疗效和成本效益。

项目成果

Within-team Patterns of Communication and Referral in Multimodal Treatment of Chronic Low Back Pain Patients by an Integrative Care Team.

综合护理团队对慢性腰痛患者多模式治疗的团队内沟通和转诊模式。

• DOI: 10.7453/gahmj.2014.076
• 发表时间: 2015
• 期刊: Global advances in health and medicine
• 作者: O'Connor,BonnieB;Eisenberg,DavidM;Buring,JulieE;Liang,CatherineL;Osypiuk,Kamila;Levy,DonaldB;Wayne,PeterM
• 通讯作者: Wayne,PeterM