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.
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Hospital Inclusion of CAM: 2005 versus 2007
From the AHA-Health Forum Surveys in 2005 & 2007
Date of survey
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2005
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2007
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Project leaders
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Sita Ananth, MHA;
William Martin, PsyD,
MPH, MA
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Sita Ananth, MHA;
Samueli Institute
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Surveyed &
responses
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6347 hospitals;
1394 respondents
21% response rate
|
|
6,439 hospitals;
748 respondents;
12% response rate
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Offer some CAM
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370 hospitals;
26.5% of respondent
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280 hospitals;
37.4 % of respondents
|
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Of the 370 respondents with
CAM programs |
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Of the 280
respondents with
CAM programs
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Location of
services
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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%)
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Top Out-Patient
Modalities
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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%)
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Top In-Patient
Modalities
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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
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Patient Demand (87%)
Mission (63%)
Clinical Effectiveness (61%)
|
|
Patient Demand (84%)
Clinical Effectiveness (61%)
Mission (57%)
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Top Payment Methods
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Self pay (81%)
3rd party (37%)
|
|
Self pay (71%)
3rd party (39%)
No charge (38%)
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Top 2 Challenges
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Budgetary expertise (67%),
physician resistance (46%)
|
|
Budgetary constraints (70%)
physician resistance (41%)
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Typical Hospital Outlay
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< $200,000 (86%),
$200-$500,000 (8%),
> $500,000 (6%)
|
|
< $200,000 (86%),
$200-$500,000 (10%),
> $500,000 (4%)
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Top metrics
for measuring
program outcomes
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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.
 Report leader Sita Ananth, MHA
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.
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|
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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.
Send your comments to
[email protected]
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|
Send your comments to
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Your Comments Forum.