The UCSD Center for Integrative Medicine: Vision, Development and Future Directions Gene A. Kallenberg, MD Executive Director, Center for Integrative Medicine Professor & Chief, Division of Family Medicine Vice Chair, Department of Family Medicine and Public Health University of California, San Diego
Introduction • Our goal for this visit is to share our concept, our strategic plan and the principles that have guided our efforts in the hope that those interested in Integrative Medicine here at PUC, a similarly science-focused academic health center, will find them useful in developing your own path. • We will also present both primary care and specialty care (oncology) viewpoints on incorporating an integrative medicine approach to patient care. • Beyond this modest goal lies the potential for inter- institutional collaboration that could enlighten us both.
What IS Integrative Medicine? “ Healing-oriented medicine that takes account of the whole person, including aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies .” University of Arizona
The Defining Principles of Integrative Medicine • Patient and practitioner are partners in the healing process. • All factors that influence health, wellness, and disease are taken into consideration, including mind, spirit, and community, as well as the body. • Appropriate use of both conventional and alternative methods facilitates the body's innate healing response. • Effective interventions that are natural and less invasive should be used whenever possible. • Integrative medicine neither rejects conventional medicine nor accepts alternative therapies uncritically. • Good medicine is based in good science. It is inquiry-driven and open to new paradigms. • Alongside the concept of treatment, the broader concepts of health promotion and the prevention of illness are paramount. • Practitioners of integrative medicine should exemplify its principles and commit themselves to self-exploration and self-development. • University of Arizona
UCSD Center for Integrative Medicine • Vision The UCSD Center for Integrative Medicine will create a model of whole-person healthcare that maximizes both caring and curing. • Mission T hrough collaboration in practice, teaching and research of healing-oriented medicine the UCSD Center for Integrative Medicine is dedicated to changing health care in a way that engages each individual's unique values and empowers them to achieve optimal health and well-being in all aspects of life.
What We Do • Clinical Care Offer integrative services throughout the UCSD Health System (HS) wherever patients are treated in whatever manner we can contribute to their healing process and well-being. This includes all outpatient clinics, the emergency room and all hospital inpatient units. • Services offered: IM consultations, OMT, acupuncture, massage/energy work, classes in MBSR, Natural Healing & Cooking, Yoga, Tai-Chi and Qi-Gong • Education Educate peer faculty, staff and learners at all levels in the Health System about the types of IM services available, the science supporting them, when they are appropriate to employ and their effectiveness in practice.
What We Do • Research Conduct research assessing the efficacy and effectiveness of IM services on patient care: clinical outcomes, cost of care and patient satisfaction (Triple Aim). • Community Collaboration Convene and meet with interested members of the San Diego community to foster understanding of how IM services can affect their well-being and clinical care, and to promote safe and effective use of IM services to improve their health and help them play active roles in their own care.
Who We Are -- cim.ucsd.edu • 6 family physician MDs IM consultations • 1 preventive medicine / nutrition & natural medicine MD, PhD, MPH nutrition consultations • 5 doctors of osteopathy osteopathic manual therapy • 7 Licensed acupuncturists • 2 massage/energy-acupressure therapists • 2 psychologists & multiple instructors MBSR classes at our Center for Mindfulness • Multiple instructors Natural Healing and Cooking Classes • Tai-Chi, Yoga and Qi-Gong instructors • Total ~35 individuals
Administrative Structure • Clinical Services • Executive Director (.3) • Managing Director (1.0) • Administrative Asst. (.75) • Medical Director (.05) • Director of Acupuncture/Massage (.2) • Inpatient Director (.25) • Education • Education Director • Medical Student Education Director (.05) • Residency Education Director (.1) • Research • Director of our Center of Excellence in Research and Teaching of Integrative Health (.5) • Director of the Krupp Endowment for IM Research (.05) • Community Collaboration • Director of Community Collaboration (.05)
Why Develop a Center for Integrative Medicine? • Our patients used these services and approaches to their own medical care and self-care already ($34-49B and ~350m visits) • A patient-centered approach to care was being increasingly and more broadly recommended across US healthcare and is being taught in our health professional schools • Data was beginning to support the efficacy of IM interventions • IM approaches were potentially very cost-effective for control of many chronic diseases that were a source of substantial healthcare spending • IM approaches were increasingly being used to complement allopathic, Western medical approaches (i.e. no longer alternative, but complementary or integrative)
Competitor Analysis Top Reasons Major Hospitals are Offering CAM Differentiation from Competition 36% Increased Clinical Effectiveness 45% Attracting New Patients 41% Patient Demand 49% Most major healthcare organizations offer CAM services and many do so by establishing IM programs. These institutions have decided to offer these services primarily to meet the demand of patients and to remain competitive in their market. Direct financial contribution by the program was not mentioned by any of the organizations participating in the survey. Projected financial benefits were the result of expected increases in the patient population receiving services from the organization
Regulatory Change • The Joint Commission’s New Pain Management Standard: • Effective January 1, 2015, for Ambulatory Care, Critical Access Hospital, Home Care, Hospital, Nursing Care Centers and Office-Based Surgery Practice Programs • Both pharmacologic and non-pharmacologic strategies have a role in the management of pain. The following examples are not exhaustive, but non- pharmacologic strategies may include the following: • physical modalities (for example, acupuncture therapy, chiropractic therapy, osteopathic manipulative treatment, massage therapy, and physical therapy), relaxation therapy, and cognitive behavioral therapy www.jointcommission.org/clarification_of_the_pain_management__standard/
The View from the N ational C enter for C omplementary and I ntegrative H ealth (NCCIH) • CHARGE: The Director of the Center shall, as appropriate, study the integration of alternative treatment, diagnostic and prevention systems, modalities and disciplines with the practice of conventional medicine as a complement to such medicine and into health care delivery systems in the United States. S.2420, July 31, 1998 • Individuals, their health care providers, and their health care systems are all, on a large scale, incorporating various practices which have origins outside of mainstream medicine into multi-pronged treatment and health promotion approaches. • This “integrative” trend among providers and health care systems is growing. Driving factors include perceived benefit in health or well- being, emerging evidence in at least some cases that perceived benefits of integrative are real and/or meaningful (e.g., management of chronic pain), and marketing of “integrative care” by health care providers to consumers. • With few exceptions, data to guide evidence-based decision making about safety and efficacy are at best preliminary .
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