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: 8536578
• 负责人: Julie E. Buring
• 金额: $ 61.21万
• 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 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8536578
• 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）：尽管补充和替代医学（CAM）在美国广泛使用，但我们在CAM决策、疗效、安全性和成本效益方面的知识存在重大差距。有几个因素导致了这一差距，包括：患者、传统护理提供者和CAM提供者之间关于CAM使用和推荐治疗的沟通有限;侧重于评价单个CAM治疗或干预的有效性和安全性，使得难以将这些结果外推到现实世界多模态CAM与传统治疗结合使用的模式;以及在现有的综合护理中心内进行的有限的实用研究。 在NCCAM的资助下，Osher补充和综合医学治疗临床中心（OCC）于2007年成立，位于布里格姆妇女医院（BWH）的门诊护理中心。最近的开放提供了一个独特的机会窗口，以实现两个目标：描述转诊和实践模式的早期演变，并评估在真实的世界环境中使用常规和CAM治疗的沟通和决策的各个方面;并提供重要的观察证据，说明综合护理团队对严重和慢性腰痛（CLBP）。 第一个目标将从四个不同的角度进行评估：对OCC的新患者进行调查;对将患者转诊至OCC的BWH医生进行调查;对BWH与转诊医生在同一部门但在两个时间点未转诊至OCC的医生进行调查;对转诊患者及其转诊医生进行深入的定性访谈。第二个目标将在一项前瞻性、观察性队列研究中进行，随访150例OCC CLBP患者和150例BWH非OCC CLBP患者的对照组，观察症状缓解、功能状态、护理满意度、生活质量、医疗利用率和生产力。将对CLBP患者以及OCC团队成员进行定性访谈，以从患者和提供者的角度描述患者治疗过程。 我们的患者和医生调查的结果将提供知识，信念，转诊，沟通水平，以及在学术医疗中心的医院环境中使用CAM的障碍和促进因素的评估，并将随着时间的推移跟踪这些行为。我们的观察性研究的结果将被用来通知和设计一个未来的随机临床试验，评估CLBP治疗的综合护理模式的疗效和成本效益。