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

描述(由申请人提供)：尽管补充和替代医学(CAM)在美国被广泛使用，但我们对CAM的决策、有效性、安全性和成本效益的了解存在显著差距。造成这一差距的因素有几个，包括：患者、传统护理提供者和CAM提供者之间关于CAM使用和推荐疗法的沟通有限；侧重于对个别CAM疗法或干预的有效性和安全性进行评估，使得很难将这些结果推断为与传统疗法结合使用的现实世界中多模式CAM的模式；以及在现有综合护理中心内进行的务实研究有限。 在NCCAM的资金支持下，Osher补充和综合医疗治疗临床中心(OCC)于2007年成立，实际位于布里格姆妇女医院(BWH)的门诊护理中心。最近的开放为实现两个目标提供了一个独特的机会之窗：描述转诊和实践模式的早期演变，并评估在现实世界环境中使用传统疗法和CAM疗法的沟通和决策的各个方面；以及提供关于综合护理团队针对严重和致残性疾病-慢性下腰痛(CLBP)的相关临床结果的有效性的重要观察证据。 第一个目标将从四个不同的角度进行评估：对OCC新患者的调查；对已将患者转介到OCC的BWH医生的调查；对BWH与转介医生相同部门的医生的调查，但他们在两个时间点没有转介到OCC；以及对转介患者及其转介医生的二元组进行深入的定性访谈。第二个目标将在前瞻性的观察性队列研究中进行，跟踪调查150名患有CLBP的OCC患者和150名BWH非OCC CLBP患者的症状缓解、功能状态、护理满意度、生活质量、医疗利用和生产力。将对CLBP患者和OCC团队成员进行定性访谈，从患者和提供者的角度描述患者的治疗过程。 我们的患者和医生调查结果将提供对知识、信念、推荐、沟通水平以及在学术医疗中心的医院环境中使用CAM的障碍和促进者的评估，并将随着时间的推移跟踪这些行为。我们的观察性研究结果将被用于通知和设计未来的随机临床试验，评估综合护理模式治疗慢性阻塞性肺疾病的疗效和成本效益。

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.