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 Hospital Association Report Finds More use of Alternatives, But There are Questions 
 
The following is one in an ongoing series of columns entitled Integrator Blog by . View all columns in series
Summary: 37% of hospitals offered some form of complementary and alternative medicine in 2007, up from 26% in 2005. This is the marquis finding from the recently published Summary of Results of the Complementary and Alternative Medicine Survey of Hospitals from the American Hospital Association/Health Forum. However, a low response rate raises questions about the extent to which the trend line is positive. In addition, inclusion of many key modalities in hospitals that offer CAM in outpatient services is actually down. Here are data and analysis from this always useful pulse on the uptake of non-conventional therapies into US hospitals. Credit AHA/Health Forum and Sita Ananth, MHA, the lead author.

AHA-Health Forum 2008 Report: 37% of Hospitals Have Some Complementary and Alternative Medicine

Summary: 37% of hospitals offered some form of complementary and alternative medicine in 2007, up from 26% in 2005. This is the marquis finding from the recently published Summary of Results of the Complementary and Alternative Medicine Survey of Hospitals from the American Hospital Association/Health Forum. However, a low response rate raises questions about the extent to which the trend line is positive. In addition, inclusion of many key modalities in hospitals that offer CAM in outpatient services is actually down. Here are data and analysis from this always useful pulse on the uptake of non-conventional therapies into US hospitals. Credit AHA/Health Forum and Sita Ananth, MHA, the lead author.
Send your comments to johnweeks@theintegratorblog.com
for inclusion in a future Integrator.

The Report and data sets from the AHA/Health Forum
can be purchased here.


Image
A subsidiary of the American Hospital Association
The marquis finding in the
3rd Biannual Complementary and Alternative Medicine (CAM) Survey of Hospitals from the American Hospital Association/Health Forum is that the percentage of hospitals with at least some CAM services jumped to 37.4% from 26.5% in 2005.  This movement is up from 7.7% in 1999, the first year the AHA included a question on CAM in one of its surveys. Yet a closer look at the findings suggest that a straight-line projection of continuing growth in hospital inclusion may be misleading. Here is a data-view from the 748 respondents (12% response rate) with some comparisons to data in an Integrator report from AHA/Health Forum's 2005 survey plus some analysis and commentary. 
_____________________________________________

Hospital Inclusion of CAM: 2005 versus 2007

From the AHA-Health Forum Surveys in 2005 & 2007



Date of survey
2005
  2007
 
Project leaders

Sita Ananth, MHA;
William Martin, PsyD,
MPH, MA
 
Sita Ananth, MHA;
  Samueli Institute
Surveyed &
responses
 
6347 hospitals;
1394 respondents
21% response rate

   
6,439 hospitals;
748 respondents;
12% response rate

Offer some CAM

370 hospitals;
26.5% of respondent
   
280 hospitals;
37.4 % of respondents


 
Of the 370 respondents with
CAM programs
   
Of the 280
respondents with
CAM programs

 
Location  of
services

Hospital-based
Wellness-Fitness Center (37%)
Hospital-based
CAM Center (15%)
Off-Oite CAM Center (11%)
Other (59%)
 
Hospital-based
Wellness-Fitness Center (24%)
Hospital-based
CAM Center (15%)
Off-site CAM Center (10%)
Other (74%)

 
Top Out-Patient
Modalities

Massage (71%)
Tai Chi/Yoga/Qi Gong (47%)
Relaxation (43%)
Acupuncture (39%)
Guided Imagery (32%)
Therapeutic Touch (30%)
   
Massage (54%)
Acupuncture (35%)
Relaxation (27%)
Meditation (25%)
Guided Imagery (24%)
Biofeedback (21%)
Top In-Patient
Modalities
 
Massage (37%)
Music Therapy (27%)
,
Therapeutic Touch (25%)
Guided Imagery (22%)
Relaxation (20%)
Acupuncture (12%)
 
Pet therapy (46%)
Massage (40%)
Music/art therapy (31%)
Guided imagery (20%)
Then, each at 18%:
Acupuncture, relaxation
training, Reiki and
therapeutic touch
 
Top 3 Reasons
to Offer CAM

Patient Demand (87%)
Mission (63%)
Clinical Effectiveness (61%)
   
Patient Demand (84%)
Clinical Effectiveness (61%)
Mission (57%)

 
Top Payment Methods
 
Self pay (81%)
3rd party (37%)
   
Self pay (71%)
3rd party (39%)

No charge (38%)

Top 2 Challenges

Budgetary expertise (67%),
physician resistance (46%)
 
Budgetary constraints (70%)
physician resistance (41%)

Typical Hospital Outlay

< $200,000 (86%),
$200-$500,000 (8%),
> $500,000 (6%)
   
< $200,000 (86%),
$200-$500,000 (10%),
> $500,000 (4%)

Top metrics
for measuring
program outcomes 

Patient satisfaction,
volume, budget,
quality
   
Patient satisfaction (86%),
volume (55%), quality (44%),


_____________________________________________


Analysis: The lower response rate in 2007 (12%) as compared to 2005 (21%) creates the awkward reality that the marquis finding of an increased percentage of hospitals with some CAM (37.4% versus 26.5%) is based on responses from significantly fewer hospitals (748 in 2007 versus 1394 in 2005).

   
The apparently robust
increase in the percentage
of hospitals with some CAM -
37.4% versus 26.5% -
may not be real.

 
One might assume that hospitals with CAM would be most likely to respond. So what explains this fall off in participation?  Bottom line: any conclusions about what is going on in 6,439 hospitals based on responses from this very small fraction (12%) seems especially questionable. The apparently robust increase in the percentage of hospitals with some CAM (37.4% in 2007 versus 26.5% in 2005) may not be real.

Image
Report leader Sita Ananth, MHA
Other patterns in the data also question whether hospital interest in CAM is significantly growing. In the out-patient environment, the level of inclusion of
the next 4 most prominent modalities in those with CAM programs is actually in decline. These 4 are acupuncture and 3 mind-body modalities: therapeutic touch, guided imagery and relaxation therapy. The in-patient story is mixed, with some inclusion up and some down-trending. Even if a higher percentage of hospitals are offering CAM, we may assume that they are offering less robust programs.

Nor do these data suggest that inclusion will trend upward at a significant pace in the years ahead. Just 11% of participating hospitals that do not offer CAM are planning to begin to offer any CAM by an average of 18 months from the late 2007 date of the survey. In hospitals with existing programs, the infrastructure for growth also appears to be wanting. Of those with CAM programs, over 50% do not have CAM in the hospital's overall strategic plan. Of the CAM programs, 70% don't have a strategic plan. If you don't know where you want to go, how are you going to get there? Only a third of the programs periodically report to the hospital's Board.

   
  A parallel shrinkage in the levels
of inclusion of specific therapies
in outpatient settings is also
evident. Even if a higher %
of hospitals is offering CAM,
we may assume that they are
offering less robust programs.

One good sign is that "physician resistance" is somewhat lower as a reason for not offering CAM (41% in 2007 versus 46% in 2005).  Yet the report quotes Integrator adviser Milt Hammerly, MD describing new forms of physician resistance that have emerged. One is that the "tolerance for change" of any sort has been tested in health system physicians. CAM may be viewed as yet another tiresome, top-down system initiative. System change challenges have created a climate in which many physicians simply don't want to try anything new. Hammerly asserts that still others may view CAM as a competitive threat.


_____________________________________________

Hospital Inclusion of CAM: Some Additional Findings

From the Health Forum 2007 Complementary
and Alternative Medicine Survey of Hospitals



Reasons for
discontinuing
CAM programs

    

Poor financial performance (55%)
Re-prioritized hospital initiatives (40%)
Lack of community interest (35%)
Inability to break even (30%)
Lack of medical staff support (30%)
General cuts to nonessential programs (25%)
 

CAM program
relationships
with the medical
staff

  Excellent/high referrals (16%)
Good/moderate referrals (40%)
Mediocra/limited referrals (32%)
Poor/few referrals (12%)


Break even
expectation


One year (6%)
Two years (14%)
Three years (24%)
Not expected to break even (56%)

_____________________________________________


Comments: First, I thank
Sita Ananth, MHA for her long-time work with Health Forum and AHA. The field has benefited greatly. I hope that AHA/Health Forum will again survey the hospitals in 2009, despite Anath's move to the Samueli Institute, where she directs the Knowledge Center in the Institute's Optimal Health Environments initiative. (A number of Ananth's co-workers at Samueli Institute also contributed to the present report.) The AHA's David Allen for made the report available for analysis this year.

Is this sober and even somewhat bleak analysis accurate on what these data say about actual movement in hospital behavior relative to CAM? Might hospital-based integration be stalled, rather than advancing? I think these data urge us to consider this analysis to be closer to the mark than what may be suggested by the marquis finding of "37% of hospitals offer CAM" which has shaped the media accounts. Your comments and perspectives are welcome. 

The Report and data sets from the AHA/Health Forum
can be purchased here.

Send your comments to johnweeks@theintegratorblog.com
for inclusion in a future Integrator.


      
 Comments Add your comment 

 About The Author
Resumes are useful in employment decisions. I provide this background so that you may understand what informs the work which you may employ in your own. I have been involved as an organizer-writer in the emerging fields......moreJohn Weeks
 
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