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 Integrator Blog - Notes from an Exceptional Experience: The North American Research Conference on Complementary and Integrative Medicine, May 12-15, 2009 
 
The following is one in an ongoing series of columns entitled Integrator Blog by . View all columns in series
Summary: The good news is that, if you missed the 2009 North American Research Conference on Complementary and Integrative Medicine, May 12-15, you can still access much of the wonderful cornucopia of what it offered. Innovision Health Media created an internet-available, searchable database of the 300+ abstracts of the keynotes, workshops, diverse symposia, posters and discussions which 810 of us from 24 countries had a chance to sample. This article introduces you to a few of my favorite things regarding the Conference's interdisciplinary content, educational sessions, whole systems and health services research. Make a mental note to attend the third in a line of these every-3rd-year gatherings, sponsored by the Consortium of Academic Health Centers for Integrative Medicine and 26 Participating Organizations, as tentatively planned for 2012.


ImageThat something happens only once every three years can create a good deal of anticipation. This is the time frame between the first two iterations of the North American Research Conference on Complementary and Integrative Medicine (NARCCIM). The first was in Edmonton in 2006. Tentative plans are being made for the next, in 2012. 

Last month, on May 12-15, 810 lucky souls from 24 countries converged on Minneapolis, Minnesota for the 2009 version, an extraordinary 3-day event which was a feast of fascinating information and a celebration of how far a movement has grown. This column is a quick scan of a very few of my favorite things. If you didn't attend, begin planning forward to the Spring of 2012 for the next iteration!

1.  The Sponsors, Leadership and a Salute to Multidisciplinary Diversity

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Conference sponsors
The conference is the anchor production of the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM, or "The Consortium" as the representatives of the 43 member academic health centers self-refer). Researchers and faculty in integrative medicine from these medical schools were much in evidence. In addition, the organizers, led this year by Aviad (Adi) Haramati, PhD, made a point at every step of the way to include other disciplines and professions.

  • The Participating Organizations were a robust list of 26 groups, ranging from the American Association of Medical Colleges to professional, educational and industry organizations representing acupuncture and Oriental medicine (AOM), naturopathic medicine, massage therapy, chiropractic, herbal products, Yoga therapy and others.
  • The program team, led by health services researcher Dan Cherkin, PhD, included Christine Goertz, DC, PhD, and Richard Hammerschlag, PhD, the co-chairs of the Research Working Group of the Academic Consortium for Complementary and Alternative Health Care (ACCAHC), a separate consortium the includes all the councils of colleges and schools for the licensed complementary healthcare fields.
  • The conventional Consortium extended a grant to ACCAHC, through which 15 students from these fields were granted scholarships to the conference.
  • Financial backers included the Massage Therapy Foundation and Northwestern Health Sciences University, a multidisciplinary university with chiropractic, AOM and massage programs.  

The drive for inclusion proved successful. The program, developed by Cherkin's team through a peer-review process, as well as the attendance at the conference itself, each manifested a deep level of integration. Many panels of speakers and featured discussions included teams from diverse backgrounds. The Consortium successfully honored its own definition of "integrative medicine" by
"mak(ing) use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing," or, in this case, to create an optimal conference. To the organizers' credit, ample time in receptions and breaks was allowed for the assembled multitudes to mix it up.

2.  Conference Materials Readily Available: Innovision Innovates as Conference's "Principal Publisher"

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Leading publisher, via Alternative Therapies in Health & Medicine
The conference team did an excellent job partnering with the leading peer-reviewed publications in integrative practice fields to publish abstracts from all of the 250 posters and scores of sessions - plenary, scientific sessions, symposia and featured discussions. (If I had one complaint, it was that there were too many times when I wanted to be more than one place at a time.) The Integrator was a minor media partner and I served on the marketing team.

Innovision Health Media took the lead at the Principal Publisher, publishing all the abstracts. These are available in a searchable database available here. It is a very efficient site which allows one to search by type of research (basic, health services, education, clinical, etc.), see a list of related topics, and then quickly click in to see the abstract desired.
Take a look! In addition, Explore! and the Journal of Alternative and Complementary Medicine each published sets of abstracts.

The table below is a brief breakdown of the number of presentations, including posters, by category of research.
_______________________

Research Presentation at NARCCIM by Category

 Type
 Approx.
Number*
Basic Science

 47
Clinical Research

 112
Health Services Research

 88
Research Methodology

 21
Education Research

 13
General Research
 20

* Quickly counted from the lists. Does not include late-breaking additions
_______________________

There are great riches here. Have fun exploring by clicking here - an interesting process even if you attended. Now, for a few of my favorite things.

Image
The other academic consortium
3.  A Meeting Between Two Consortia


NARCCIM including numerous pre-conference events. One which was notable, even historic, was a Monday May 11 meeting of members of the Steering Committee of the conference' sponsoring organization, the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) and the leadership of the Academic Consortium for Complementary and Alternative Health Care (ACCAHC), the consortium of CAM academics noted above. ACCAHC, for which I serve as executive director, deliberately co-located its own leadership meeting in Minnesota, May 10-12, to facilitate participation in the conference by it members. ACCAHC also wanted to
follow up on a reception between executive committee members from both consortia at NARCCIM in 2006 in Edmonton and create the possibility of a larger meeting with their CAHCIM counterparts. In Minnesota, the joint meeting took place the afternoon and evening of May 11.

The 4-hour joint meeting began with introductions and short slide show presentations on each consortium's make-up and activities. The group of roughly 75 then broke into hour-long joint meetings of members of the 3 working groups of each consortium (Research, Clinical Care, Education) and of the two executive teams. Members of the working groups identified projects on which they might collaborate and the executive teams chose to meet in regular phone calls to swap information. A reception and dinner, hosted by CAHCIM, followed. In a note to ACCAHC leaders following the meeting, CAHCIM chair Vic Sierpina, MD and chair-elect Adam Perlman, MD, MPH, wrote:
“We enjoyed very much the camaraderie and believe that it is very important that we keep appraised of each others' efforts. It seemed as though some very lively discussions occurred within the working groups!”
_______________________

Image
Attendees of the May 11, 2009 meeting between members of the Steering Committee of the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM), and leaders of the Academic Consortium for Complementary and Alternative Health Care (ACCAHC)

_______________________

Image
Cheryl Ritenbaugh, PhD, MPH
4.  Outcomes from Integrative Health Care: What Patients Say We Should  Measure

Researchers in integrative medicine, stated presenter Angela Greene, "need to make sure that the outcomes chosen are those that matter most to the users." Green was part of a team which presented an oral poster session entitled "Perceived Benefits of Complementary and Alternative Medicine: A Whole Systems Research Perspective." In 5 focus groups involving 36 participants who were self-identified as having benefited from their complementary care interventions, the researchers discovered, for instance, that users believed that the care had helped them in making positive lifestyle changes. They concluded: "In addition, (patients) identified empowerment, increased hope and spiritual growth as results of receiving CAM treatments and identified CAM use as fostering behavioral changes such as increased exercise, smoking cessation, and improving their diets and described how CAM therapists fostered these changes." Search here under Greene AM, McCaffrey A, Sirois F, Walsh E. Notably, an entire Symposium on "Developing Patient-Centered Measures for Outcomes of CAM Therapies" was also offered, led by whole systems researcher Cheryl Ritenbaugh, PhD, MPH. (Search Ritenbaugh C, Coons S, Koithan M, Nichter M, Nichter M, Sims C, Elder C, Sutherland E, Verhoef M, Bell I.)
Comment: This message is an excellent one to get in the hands of President Obama (see his comments on acupuncture and on prevention), US Senator Tom Harkin and others who have, among health reform leaders, at least the beginning of a  grasp of the clinical dimensions to how we can foster prevention and wellness. The case for this value of integrative practices has not yet penetrated most of the policy dialogue. Such a focus in research investment may limit the fallout from the negative outcomes of some CAM research, for which NCCAM is regularly blasted in the media, which typically failed to either look at whole systems input or such patient outcomes as these. 
Image
Christine Goertz, DC, PhD
5.  Efforts to Create Research Which Better Reflects Integrative Practices


For years, a complaint among many integrative practice professionals has been that research does not adequately reflect actual practices. Attempts to belly-up to the very challenging bar of honoring the multiple inputs of integrative care were the subject of a variety of sessions. Christine Goertz, DC, PhD took this on directly in leading a multidisciplinary featured discussion entitled "Practice-Based Research Networks (PBRN): Meeting the Challenge of Reflecting CAM Clinical Practices." The group explored how PBRNs "are attractive to CAM researchers because the large-scale observational studies conducted in PBRNs allow CAM therapies to be studied in the complex way in which they are clinically practiced." (Search Goertz.) Taking a different approach, Ritenbaugh led a symposium entitled "Whole Systems Research Becomes Real: New Results and Next Steps."  Ritenbaugh's team included a number of researchers who helped elevate the focus on whole systems at the 2006 conference in Edmonton. (See the Integrator article Political-Economic Issues in Whole Systems Research Revealed by JACM Roundtable, December 8, 2006.) See also "How Can CAM Research Better Reflect CAM Practices (search Zwickey).
Comment: At the meeting, I was asked informally by program chair Cherkin what I noticed as changes in the program from 2006 to 2009. One theme which clearly seems to have matured in this community over recent years is this effort to make research better conform with whole person practice, and patient outcomes. These are healthy directions, which we now must make sure that funders, particularly at NCCAM, also elevate. Happily NCCAM director Josephine Briggs, MD has stated that she would like to move the agenda toward more "effectiveness research" and "real world outcomes." Hopefully this means supporting the nascent exploration of whole practices. (See New "Effectiveness" Direction for NCCAM: An Interview with Director Josephine Briggs, MD, November 26, 2008.)
6.  Making the Evidence Case for Integration in a Large Hospital System

Hands down, the most ambitious effort to thoroughly integrate complementary therapies into a full-service hospital system, inpatient and outpatient, is the initiative in Minnesota's Allina Hospitals and Clinics. The commitment comes from the CEO on down, with the center of generative energy the Penny George Institute inside Abbott Northwestern Hospital, part of the Allina network. Allina plans to expand integrative services throughout the 8 hospital system. The services include mind-body therapies via relaxation response, acupuncture, acupressure, massage therapy, healing touch, music therapy, aromatherapy, Korean hand therapy, or reflexology.
The use data on thus far are quite intriguing, based on over 43,000 visits! Of the 15,210 patients served, roughly 66% were "new to CAM," according to panelist Lori Knutson, RN. (Searching under Dusek on the abstract site also brings up 2 clinical trials carried out through the Allina program.)
_______________________

Data on Inpatient Integrative Care Visits
from Abbott Northwestern Hospital


Time period covered
  July 2004-
June 2008
Total patients referred
  16,770
Total patients seen
   15, 210
Average/mo. 2004
  186
Average/mo. 2005
  242
Average/mo. 2006
  354
Average/mo. 2007
  381
Average/mo. 2008
  394
Total inpatient visits
  43,276
Average patient age
  52.6 years
 
Percvent in services by hospital areas
   
 Medical/surgical    33%
 Neurology/rehab.    26%
 Orthopedics and spine
   14%
 Women's health
   14%
Cardiovascular
  13%
Mean duration of individual sessions
  24 minutes
Average # visits/patient
  2.8 visits

Source: Abstract Dusek JA, Knutson L, Plotnikoff G.  Integrative Medicine at Abbott Northwestern Hospital: the first 43 276 integrative medicine inpatient visits.
_______________________

Image
Wendy Weber, ND, PhD
7.  Educational Research:Transforming the Culture of Research at CAM Schools: Evidenced-Informed Care


Wendy Weber, ND, PhD, formerly at Bastyr University and now a program officer with NIH NCCAM headed up a fascinating panel entitled "Changing the Culture of CAM Institutions Toward an Evidence-Based Approach-One R-25 at a Time." The session consisted of reports from beneficiaries of this exceptional NIH NCCAM initiative which provided funds to CAM schools, partnered with conventional medical schools, to work on ways to shift the culture relative to evidence and research in their schools. One speaker after another offered innovative strategies and tools for shifting culture. At Palmer College of Chiropractic researchers acknowledged that "the old culture of intuitive, patient connection" approaches as the basis of clinical decisions "is still dominant." They created a "Cultural Change Task Force" to head up their initiative. More than one speaker noted that even in institutions with significant investments in research, research tends to "be in a silo" and separate from the rest of the institution, as noted by Roni Evans, DC, MS. at the Wolfe-Harris Center for Clinical Studies at Northwestern Health Sciences University. One interesting shift was away from the "evidence-based medicine" term to "evidence-informed care" or "research-informed clinical practice," as used by Susan Fleishman, a researcher with Oregon College of Oriental Medicine. Heather Zwickey, PhD, a presenter on behalf of the Helfgott Research Institute of National College of Natural Medicine (NCNM) noted that needs were different with distinct disciplines. With the naturopathic medical program, Zwickey noted, the focus was "more on how they do research rather than whether they did it," whereas those in NCNM's Classical Chinese Medicine school tended to base decision processes on "ancient Chinese texts, and there was no real interest" in research. These grants appear to be developing numerous tools that should be useful to many institutions. (Search Weber.)

Evidence of the shifting landscape is some exciting development of joint degree programs through a cluster of CAM schools and Oregon Health Science University, captured in a session entitled: ""Collaborating Across Disciplines to Develop Joint Degree Programs in CAM and Integrative Medicine." (Search Nedrow.)

Image
David Rakel, MD
8.  Integration in Medical Health Homes: A Wild Exploration of the Whole of Care


I had a hand in developing a session led by David Rakel, MD, entitled "Health-Oriented Medical Homes: Defining Cost-Effective Interdisciplinary Integrated healthcare Teams in the Outpatient Environment." The medical home movement figures significantly in Obama health reform efforts. Rakel's panel included Douglas Hiza, from Blue Cross Blue Shield of Minnesota, health economist and researcher Patricia Herman, ND, PhD, consultant Stephen Bolles, DC, and the clinical director for the ambitious Allina program noted above, Lori Knutson, RN. The presentations from the panelists led to a wild discussion by the 60+ participants of the myriad strategies to create health in communities.
Most felt that a better term than "medical home" would be "relationship-centered health home.” To facilitate the transition will require that we "create interdisciplinary teams that learn from non-physician disciplines to transition to a model of care more deeply committed to health promotion." Many questioned whether we can "create health homes within a culture that encourages fast food, inactivity, social isolation and the perception of a quick fix in a pill?" My own contribution to the discussion was to push for care via groups, citing Michael Smith, MD, the founder of the group-acupuncture movement in the United States, saying: “If you want to empower patients, put more patients than providers in the room.” An interesting contribution to the discussion of what may become the cornerstone of U.S. healthcare. Search Rakel.


Making It happening: The Generous Georges, Plus

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Penny & Bill George
As a person who spends half of his professional time as a writer and the other half as a social entrepreneur in building a new organization, ACCAHC, noted above, I am always aware of where it is that the wherewithal to mount a conference like this comes, especially for a not-for-profit like CAHCIM.
Susan Folkman, PhD and Mary Jo Kreitzer, PhD, RN, immediate past chair and vice-chair, respectively, of the Consortium, were widely credited for their exceptional work in recruiting resources. Over 15 organizations are credited with funding a support, including those noted above as well as Blue Cross Blue Shield of Minnesota, NIH NCCAM, the Ted and Roberta Mann Foundation, Bernard Osher Foundation and others.

Deserving special commendation for helping lock down and secure the path to this conference 3 years ago, shortly after they attended the first NARCCIM conference, are Bill and Penny George of the George Family Foundation. Their early commitment inspired the confidence and lift off for CAHCIM. Their contributions here, and elsewhere, to quality healthcare cannot be understated. Here is hoping that other funders will step up early to insure that planning for the 2012 conference can begin with similar confidence. A terrific interdisciplinary community is developing around this robust conference. Explore the Innovision abstract site, and make a note to come in 2012!



Send your comments to johnweeks@theintegratorblog.com
for inclusion in a future Your Comments Forum.
      
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 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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