Research on integrative healthcare: context and priorities.

Memorial Sloan-Kettering Cancer Center, 1429 First Avenue, New York, NY 10021, USA.
EXPLORE The Journal of Science and Healing (Impact Factor: 0.94). 05/2010; 6(3):143-58. DOI: 10.1016/j.explore.2010.03.007
Source: PubMed

ABSTRACT It is important that integrative healthcare research be conducted to optimize the effectiveness, safety, costs, and social and economic impact of prospective, personalized, patient-centered, comprehensive, and holistic healthcare that focuses on well-being as well as disease management, and that the research itself be well understood. The scope of this research extends beyond evaluation of specific therapies, to include evaluations of multimodality whole system intervention, practitioner-patient relationships, patient goals and priorities, promoting self-care and resilience, personalized diagnostic and therapeutic measures, practitioner well-being, the comparative effectiveness of different educational and outreach strategies in improving health and healthcare, and the environmental/social causes and consequence of health and healthcare. In this paper, we describe the state of the science of research on integrative healthcare, research needs, and opportunities offered by cutting-edge research tools. We propose a framework for setting priorities in integrative health research, list areas for discussion, and pose a few questions on a future research agenda.

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    ABSTRACT: The term, integrative medicine (IM), has evolved over time to describe treatment which uses both CAM (complementary and alternative medicine) and conventional approaches. Drawing from the experience of experts in different geographical areas, including USA, UK, Australia, and China, this review aimed to identify key elements which could be used to define IM and to develop a checklist for reporting IM in clinical trials. Method A total of 54 sources were searched (including websites of governments, key authorities, representative clinical sites, academic journals, relevant textbooks) to identify definitions of IM from the four countries from 1990 - 2014. Key elements characterizing IM were extracted and categorized in a thematic approach in order to identify items to consider when reporting IM in research studies. Results Seventeen definitions were identified and extracted from 17 sources. The remaining thirty seven sources did not provide a definition of IM. The most common key elements which defined IM were: practitioner-patient relationship; using aspects of both CAM and conventional medicine; goals of health and healing; holistic approach; and optimum treatment. Integration was also defined at three levels: theoretical, diagnostic and therapeutic. A potential check list of items is proposed for reporting IM in clinical studies. Conclusion This paper identifies the key elements which define IM and provides a potential reporting guide for developing IM clinical trials which could be used in narrative/systematic reviews. Further debate, discussion and input is now needed from the research and clinical IM communities to further advance this agenda.
    European Journal of Integrative Medicine 01/2015; · 0.65 Impact Factor
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    ABSTRACT: There are many challenges to developing an evidence base for Traditional Chinese Medicine and Integrative East-West Medicine. This article offers a review of these challenges alongside an introduction and review of several innovations in healthcare research that have successfully been applied to the study of Traditional Chinese Medicine and Integrative Medicine. Such innovations include developments in Whole Systems Research, Comparative Effectiveness Research, Health Services Research, and qualitative Social Sciences Research. Each of these approaches expands upon conventional approaches to clinical research and can also be combined with clinical trial data to yield a mixed-methods approach. We conclude with a commentary on the necessity for such mixed methods studies in the continued establishment of an evidence base for TCM and IM.
    Journal of traditional and complementary medicine. 01/2012; 2(3):158-163.
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    ABSTRACT: Integrative medicine (IM) is a patient-centered, healing-oriented clinical paradigm that explicitly includes all appropriate therapeutic approaches whether they originate in conventional or complementary medicine (CM). While there is some evidence for the clinical and cost-effectiveness of IM practice models, the existing evidence base for IM depends largely on studies of individual CM therapies. This may in part be due to the methodological challenges inherent in evaluating a complex intervention (i.e., many interacting components applied flexibly and with tailoring) such as IM. This study will use a combination of observational quantitative and qualitative methods to rigorously measure the health and healthcare utilization outcomes of the University of Arizona Integrative Health Center (UAIHC), an IM adult primary care clinic in Phoenix, Arizona. There are four groups of study participants. The primary group consists of clinic patients for whom clinical and cost outcomes will be tracked indicating the impact of the UAIHC clinic (n = 500). In addition to comparing outcomes pre/post clinic enrollment, where possible, these outcomes will be compared to those of two matched control groups, and for some self-report measures, to regional and national data. The second and third study groups consist of clinic patients (n = 180) and clinic personnel (n = 15-20) from whom fidelity data (i.e., data indicating the extent to which the IM practice model was implemented as planned) will be collected. These data will be analyzed to determine the exact nature of the intervention as implemented and to provide covariates to the outcomes analyses as the clinic evolves. The fourth group is made up of patients (n = 8) whose path through the clinic will be studied in detail using qualitative (periodic semi-structured interviews) methods. These data will be used to develop hypotheses regarding how the clinic works. The US health care system needs new models of care that are more patient-centered and empower patients to make positive lifestyle changes. These models have the potential to reduce the burden of chronic disease, lower the cost of healthcare, and offer a sustainable financial paradigm for our nation. This protocol has been designed to test whether the UAIHC can achieve this potential.Trial registration: Clinical NCT01785485.
    BMC Complementary and Alternative Medicine 04/2014; 14(1):132. · 1.88 Impact Factor


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Aug 12, 2014