A source of information for Hospital-practice Acupuncturists and their Hospital Sponsors. This blog is part of the Hospital Handbook project which also includes social network sites to start or continue topic discussion.
Goals: to share collective wisdom of hospital practice
to create community
to encourage each other
to improve our knowledge and practice standards together
Medicare, Medicaid, insurance coverage, major hospital insurance entities, federal health care coverage policy, health care policy
CMS and
acupuncture coverage for LBP
The U.S. Center for Medicare and Medicaid Services (CMS), whose coverage policies are intertwined in hospital and medical center systems, has announced a call for public comment on the topic: “acupuncture coverage for low back pain”.
To my knowledge, this is the first time in history the
CMS has ever announced a public comment call for anything related to coverage
of acupuncture services.Tell your hospital
sponsors and advocates.If CMS
reimbursed for acupuncture and other integrative health therapies, that would
be a major milestone.
CMS is under the U.S. Department of Health and Human
Services (HHS).HHS is an enormous
department that also contains the National Institutes of Health
(NIH) and the Agency for Healthcare Research and Quality (AHRQ)
“In response to the U.S.
opioid crisis, HHS is focused on preventing opioid use disorder and providing
more evidence-based non-pharmacologic treatment options for chronic pain. The
[AHRQ, CMS, and NIH] are collaborating in this effort.”In June 2018, AHRQ “published a systematic
review of noninvasive, nonpharmacological treatment for chronic pain.”“This review included assessment of several
nonpharmacological interventions, including exercise, acupuncture, spinal
manipulation, and multidisciplinary rehabilitation for [chronic low back pain]
CLBP. “
“The NIH recently issued a Funding Opportunity Announcement
for interested parties to apply to conduct an efficient, large-scale pragmatic
trial to evaluate the impact of, and strategies to best implement, acupuncture
treatment of older adults (65 years and older) with chronic low back pain.”
“CMS is opening this national coverage analysis (NCA) to
complete a thorough review of the evidence to determine if acupuncture for CLBP
is reasonable and necessary under the Medicare program.CMS is soliciting public comment on this
topic.We are particularly interested in
comments that include scientific evidence and discuss appropriate clinicians
and training requirements to provide acupuncture that improves health
outcomes.In addition, for commenters
recommending Coverage with Evidence Development, we are interested in comments
related to appropriate outcomes and study designs.While CMS has conducted previous national
coverage analyses on acupuncture, the scope of this current review is limited
to acupuncture for chronic low back pain.”
key words: research literacy, funding and grants, sharing related research in the field, research in integrative health
The January Research Roundup
(and funding announcements!)
Review of the "Research and Metrics Thursdays" theme from the public Facebook Page and newsletter
NCCIH and NIH Research Funding Opportunity--the HEAL Initiative
NCCIH and NIH funding if you work in pain management or addiction, especially the field of opioid addiction. If you have heard me talk about the National Pain Strategy document the past couple years, HEAL builds upon parts of the work laid out in that very large federal public document.
The recordings from this conference are now available to
view. I added the NAM playlist for this
conference to the HH Project channel’s library.
Thank you to ACIH for announcing this information.
The NAM conference was 2 days, so the recordings playlist is
long. So far, I recommend the first
video with Dr. Cherkin.
Massage
Therapy Foundation Poster Abstract Submission deadline 1.31.2019
For those of you working with or leading massage therapists and
collecting metrics, the 2019 call for poster abstracts for the International
Massage Therapy Research Conference (IMTRC) is out:
The IMTRC is held once every 3 years. It is “an opportunity to learn the latest
research, connect with colleagues, and gain insight into best practices in
massage therapy.” And it “brings together thought leaders in the profession and
educators to discuss massage therapy innovations”
The next IMTRC conference is May 9-10, 2019 in Alexandria,
Virginia.
Massage
Therapy Foundation Research Grants for 2019—applications are now open. Submission deadline is March 1st,
2019.
“Massage Therapy Foundation Research Grants are awarded to those
conducting studies that seek to advance our understanding of specific
therapeutic applications of massage, public perceptions of and attitudes toward
massage therapy, and the role of massage therapy in health care delivery.”
Massage
Therapy Foundation Community Service Grants for 2019—applications
are now open.
Submission deadline is
April 1st, 2019
If you work with a 501c3 organization providing massage, you may
qualify. They say they take applications
from the U.S., internationally, and have a specific grant opportunity for those
providing massage therapy in northern Illinois.
Learn more about this community service grant here: http://massagetherapyfoundation.org/grants-and-contests/community-service-grants/
Massage therapy case report submissions
The Massage Therapy Foundation also accepts case reports from
practitioners for their journal publication, International Journal of Therapeutic Massage & Bodywork (IJTMB)
and runs a student case report contest.
Learn more here: http://massagetherapyfoundation.org/grants-and-contests/case-report-contest/
FDA Roadmap Series with the National Health Council
The January 17th, 2019, webinar was on "Untangling the Terms: Endpoints, Items, Outcomes, PROs, PROMS, PRO-PMs" with Ashley Slagle, MS, PhD. For more about this series and to watch the latest webinar, go to the FDA Roadmap Lunchtime Listen recommendation post.
Breathwork, a foundation in Traditional Chinese Medicine practice, and a research article
Research Thursday...Breathwork
As an east Asian medicine practitioner (acupuncturist) I have been teaching my
patients diaphragmatic breathing on day one and reinforced practice throughout
treatment course with related self-care homework. This breathing practice often
also called "belly breathing" has been known for a long time to help
us consciously switch our breathing state into the parasympathetic state (rest
and digest). Because, in our modern world, most people go about their day in
sympathetic state of breathing (fight or flight). Breathwork, the conscious
control of your breath, is the foundation of qi gong and mindfulness practices.
More recently, research has been conducted to test these age-old
practices, such as this article available on PubMed. --Megan
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key concepts: improving public health through whole systems nutrition, patient-centered care, Traditional East Asian Medicine paradigm of wellness, incorporating integrative health paradigms into modern health care system practices, teaching cooking skills to improve health, teaching patients self-care, modifying determinants of health through changing individual behavior around eating & cooking..nutrition keywords: mind-body medicine, integrative health, community health and wellness, learning nutrition for health, Teaching Kitchen Collaborative (TKC), Healthy Kitchens Healthy Lives® conference TCM = Traditional Chinese Medicine NCCAOM® = National Certification Commission on Acupuncture and Oriental Medicine HKHL = Healthy Kitchens, Healthy Lives®
“If a patient has a chronic condition, first modify diet and lifestyle, then add medicine”. –paraphrase, inspired by Sun Si Miao
In East Asian Medicine, we know that, for best
long-term self-care and health maintenance, we prescribe patients foods to incorporate in their diet. Why? To
manage their conditions and support their constitution. For example, individualized
TCM nutrition consults were a self-care session I would do with my chronic pain
patients when they were interested in learning more about food as a basic support system for health. As a board-certified TCM
herbalist (NCCAOM®-board certification), it took me time to research and put
their personalized plan together. And, for a patient, modifying diet takes courage and
commitment and follow up.
There is a new resource for helping patients learn and practice cooking healthy meals coming to a neighborhood medical facility or academic center near you, the "Teaching Kitchens". Well, maybe not so new. Several of these teaching kitchens have been around for a decade, but the hope is, that with the collaborative now helping stand-alone centers connect to more resources, that the movement will grow and expand. What is this new resource for providers and patients? The Teaching Kitchen Collaborative
Twenty years ago, Dr. David Eisenberg noticed that few health professionals understood the science of nutrition and most of them knew even less on how to cook healthy meals for themselves, let alone teach such skills to their patients. So, he worked with a team (Harvard School of Public Health and the Culinary Institute of America) to create an annual conference for health care professionals to bring together physicians, dietitians, nurses, allied health professionals, hospital administrators, and culinary specialists together, the Healthy Kitchens, Healthy Lives® conference, the first of which was in 2006 [Eisenburg, JACM, July 2018],
Dr. Eisenberg was an early advocate of the integrative health paradigm and, from the enthusiasm and success of the Healthy Kitchens Healthy Lives® conference, launched The Teaching Kitchen Collaborative (TKC).
The resource-sharing collective that the TKC can be, has the potential to encourage academic health institutions to recognize that nutrition and lifestyle change is a viable part of the treatment plan.
TKC is a "data-driven, taste-driven, whole system, experiential ... transformation campaign to put food, nutrition, and lifestyle front and center, in transitioning our medical industry toward ... a health care system." [Eisenburg, JACM, July 2018]
TKC launched in 2016 by the Harvard T.H. Chan School of Public Health-Department of Nutrition and The Culinary Institute of America (CIA). The TKC "is an invitational network of over 30 organizations using teaching kitchen facilities as catalysts of enhanced personal and public health. The TKC's mission is to enable early adopters to learn about one another's facilities and educational programs, to develop best practices for reproducing and scaling emerging models, and to document the clinical, behavioral, and financial impact of teaching kitchens for a broad range of populations."
Individual Teaching Kitchens include:
The Cleveland Clinic Center for Lifestyle Medicine
Maine General Health
Kaiser Permanente San Francisco Medical Center
Turner Farm with University of Cincinnati Center for Integrative Health and Wellness
University of Michigan's MHealthy
University of Minnesota's Center for Spirituality and Healing
Vanderbilt University Medical Center's Osher Center for Integrative Medicine and Center for Biomedical Ethics
The Sampson Family Branch of YMCA Greater Pittsburgh
The Teaching Kitchen Collaborative is a movement to connect teaching kitchens to each other. Because a Teaching Kitchen can, potentially, be a "catalyst of enhanced personal and public health across medical, corporate, school, and community settings.”
The TKC regularly hosts research days or other opportunities to share your program’s story, progress, and research. If you are already doing this work, the TKC seems like a great way to share what you are doing and be connected to others doing similar work. It seems like it would be a good place to support each other while changing the U.S. culture of health, wellness, and “food as grounding for health”.
Why join the TKC?
For all the reasons, watch the video below. Here are some useful quotes from the video:
from long-term research studies:
“We've learned that healthy dietary choices have a huge impact on the number of years that we live and how we feel during those years that we're alive and the teaching kitchen collaborative is a way to translate what we've learned into the… meals that people can have available and enjoy.” minute 0:11 Walter C. Willett, MD, DrPH
On benefits of being a member:
"tap into the expertise of all the other members on things like outcomes based research” minute 3:27
“It's just been fabulous hearing from all the other members, the discussions, the collaborations, and opportunities that we have going forward to work as teams and across institutions all over the country” minute 03:32
“The benefit from being part of the collaborative is [it] helps… resource good information. So, I see it as it’s not just a network of people collaborating together, but… it will … be a rich database…to access…the research... It is a network, too, so the ability to develop relationships with people around the country--for that matter around the world--is an opportunity that I think we couldn’t have gotten anywhere else.” Lori Knutson, RN minute 4.56
TKC kitchens are places/groups
“who are using kitchens as catalysts of personal and societal health enhancement. [Teaching kitchens are] the vehicle to teach people about food, nutrition, and new habits.” minute 00:31
A teaching kitchen is “a platform to really acknowledge the crucial role of nutrition and dietary information in the entire whole look at a person's lifestyle choices and wellness” minute 01:40
“[Teaching] kitchens, when used appropriately for different populations in
different settings, will change behaviors for the better…will change health
outcomes for the better…will be sustained changes."
"And ultimately we hope to prove that they
will change [lower overall population healthcare] costs either by preventing
chronic disease [or by] bringing people with chronic disease portfolios back to
a healthier state.” David Eisenberg, MD minute 4.19
“So I think the capacity for multi-site research trials around food and
mindful living and exercise and movement is enormous to be able to scale up as
opposed to a one kitchen .”[TKC has] “the capacity to reach so many more kids and families.The capacity to prevent cardiovascular
disease…prevent diabetes and hypertension…prevent the major chronic conditions
that we know are very heavily influenced by lifestyle… the capacity as a
collective group is enormous.” Sian Cotton, PhD minute 5.16
“But the goal is to show
that we can build reproducible teaching kitchens that will change our society for
the better on the individual basis and across populations.And that we will also save money while doing
that.” David Eisenberg, MD minute 5.48
The Journal of Alternative and Complementary Medicine.Volume 24, no. 7.Teaching Kitchen Collaborative Research Day Abstracts. The Estate Yountville, Napa Valley, CA, USA. February 7th, 2018
“A day of original research and innovative strategies involving teaching kitchens and their potential to positively impact behaviors, improve health outcomes, and reduce costs.”
video of the rooftop farm and how it connects to their Teaching Kitchen and the hospital's nutrition services: https://youtu.be/1bM-V_ySC_w
🥕🥗
If you enjoyed this post, subscribe to our email list for the latest updates and follow us for "research and metrics Thursdays" on the public Facebook Page.
You can support this community-wisdom-sharing work by buying me a coffee or sponsoring a newsletter via our website. Thank you.
Research Funding Opportunity--NCCIH and NIH funding if you work in pain management or addiction, especially the field of opioid addiction. Check out the new (12.10.2018) funding announcements related to the NIH HEAL initiative. Learn more about the HEAL initiative at this webpage. If you have heard me talk about the National Pain Strategy document the past couple years, HEAL builds upon parts of the work laid out in that very large federal public document.
Recommended Studies to Read (started this in the summer and fall newsletters)
December
"Case Reports of Acupuncturists and Massage Therapists at Mayo Clinic: New Allies in Expediting Patient Diagnoses". Explore March/April 2018. https://doi.org/10.1016/j.explore.2017.02.008
Adam S. Reinstein, Lauren O. Erickson, Kristen H. Griffin, Rachael L. Rivard, Christopher E. Kapsner, Michael D. Finch, Jeffery A. Dusek; Acceptability, Adaptation, and Clinical Outcomes of Acupuncture Provided in the Emergency Department: A Retrospective Pilot Study, Pain Medicine, Volume 18, Issue 1, 1 January 2017, p.169-178. https://doi.org/10.1093/pm/pnv114
87% of the integrative medicine services were massage therapy performed by an NCBTMB certified massage therapist and 9% were acupuncture services by an LAc.
Both services were found to statistically significantly decrease pain level post-treatment.
Over 1/3 of the hospitalized patients fell asleep during treatment, which researchers found fascinating as future research potential since good quality sleep/rest helps decrease need for medications (whether it is meds to induce sleep or meds to decrease pain because lack of sleep increases pain and other symptoms), and significantly improves outcomes in an environment (inpatient hospital space) that is not naturally conducive to rest.
source/citation: Stephanie D. Clark, Brent A. Bauer, Sairey Vitek, Susanne M. Cutshall. Effect of Integrative Medicine Services on Pain for Hospitalized Patients at an Academic Health Center. Explore: The Journal of Science and Healing. 2018. https://doi.org/10.1016/j.explore.2018.07.006
September--see the newsletter, under "Metrics and Research Thursday" for full list.
Tai Chi for Fibromyalgia. study highlight in September (BMJ visual abstract image): Tai Chi for fibromyalgia significantly improves symptoms compared to exercise, particularly at longer-term (6 months) practice and interventions.
My take-away from the article: keep practicing Tai Chi as part of your health and wellness routine!
Metrics: Don't underestimate the simplicity and usefulness of patient satisfaction surveys as one of your clinic's metrics
"We found that hospitals' patient satisfaction scores are useful signals of quality, which surprised me to some extent," said Joseph Doyle, an economist at M.I.T. and one of the studies authors.
"Hospitals with more satisfied patients have lower mortality rates, as well as lower readmission rates." New York Times article. 2017.07.24
Original study is a working paper, Evaluating Measures of Hospital Qualityby Joseph Doyle, John Graves, and Jonathan Gruber. National Bureau of Economic Research (NBER), working paper no.23166, issued in February 2017.
Research and delivery method practicality for teaching self-care basic breathing and meditation techniques: email and mobile app.
This study targeted oncology clinicians, who have a high burn-out rate. What delivery method (tool) allows ease-of-access and may increase participant compliance for studying a self-care therapy? possibly email and/or mobile apps. More research needed.
Carie Heeter and Rebecca Lehto. Meditation App Benefits Hospice and Palliative Care Clinicians. Oncology Nursing News. July 31, 2018.
citation: JA Dusek, Griffin KH, Finch MD, Rivard RL, Watson D. Cost Savings from Reducing Pain through Delivery of Integrative Medicine Program. The Journal of Alternative and Complementary Medicine. Jun 2018. https://doi.org/10.1089/acm.2017.0203
For more on the topic of research
follow the tag/label in this blog for "research literacy"
If you enjoyed this post, subscribe to our email list for the latest updates and follow us for "research and metrics Thursdays" on the public Facebook Page.
You can support this community-wisdom-sharing work by
buying me a coffee or sponsoring a newsletter via our website. Thank you.
key words: self-care, practitioner resilience, wellness, mindfulness practices; mindful cup of tea, mindfulness learning with kids, "forest bathing"--nature the outdoors and your health, dealing with holiday stress
The December Self-Care Roundup
Some inspiration from the Self-Care Saturdays theme over at our public Facebook Page
Practice mindfulness or "being-in-the-present-moment" with a warm cuppa. My kids do this well with their hot chocolate lately--down to watching the marshmallows melt.
This is my family's 2018 favorite and the book is based on her songs. I recommend getting the matching songs; most of them are part of her Mindful Moments for Kids music compilation. More at this blogpost. If you follow an Amazon affiliate link from our blogpost and buy within a few hours, a few pennies of your purchase go to the Project. However, if you want to support the Project the best and most direct way is through our website. Thank you.
Have you heard about "forest bathing" or want to read more about the health benefits of spending time outdoors?
Check out these recommendations...🙂🏞🧗♀️🛶🚲🏔🎣☕️ Nature, the Outdoors, and Your Health on our Gift Ideas page, just below the "outdoor fun" section:
Forest Bathing: how trees can help you find health and happiness
Shinrin Yoku: The Japanese Art of Forest Bathing
The Nature Fix: why nature makes us happier, healthier, and more creative by Florence Williams
Blue Mind: the surprising science that shows how being near, in, on, or under water can make you happier, healthier, more connected and better at what you do by Wallace J. Nichols
The Lost Art of Reading Nature's Signs: use outdoor clues to find your way, predict the weather, locate water, track animals--and other forgotten skills of natural navigation by Tristan Gooley
Self-care check in...how are you doing today with the holiday stress? Challenged to stay grounded? (12.21.2018)
Take a moment while you are reading this and breathe several belly breaths (diaphragmatic breathing) and stretch.
It's the longest night of the year tonight. Great time to be quiet in the evenings and enjoy the starlight or the bright winter moon (if you have minimal cloud cover). Please share a photo of your night sky when you take time to go outdoors this weekend. For all of you in stormy weather conditions, stay safe and maybe share a pic of your warm mug of cocoa cheer.
"Remember how amazing you felt the last time you hit the gym or took a hike in the woods? How clear and calm you felt after your last yoga class? Exercise can settle your mind. It can make you feel refreshed from head to toe. It helps to dissolve tension in places you may not have realized were tense. You want to remember this feeling. The next time you exercise, pause for a few minutes afterward. Sit down or lie down to fully savor the post-exercise glow....The state of your body reflects the state of your mind. A good walk clears away the mental cobwebs." Read more atWinter Got You Down? article on Mindful.org.
Get Outside and Move!
This 6-month study found that exercise (walking or bicycling) for 30 minutes 3x/week improved your brain's function. For the study group, about age 65 - 90+, 6 months of exercise at this rate lowered the "brain age" by 9 years.
My takeaways:
Not moving/sedentary lifestyle is not good for your brain
You can reverse the effects of a sedentary lifestyle by moving, at least 30 minutes at a time. Every day if possible.
With all the data now on health benefits of being outdoors and in nature, for that extra health boost: do your movement time...
Outdoors--better if it is a green area (assuming no smog or other air pollution warnings for your area that day), or woods or near a large body of water (lake, sea)
Do some gardening every week--working with healthy soil is good for our brains, too
You can read more about the health benefits of time spend outdoors in the book, Nature Fix. You can follow the link to the Amazon store for this book in paperback or audiobook at our gift ideas page under "outdoor fun and health benefits of nature".
"Be proactive this holiday season to combat loneliness or to help others do the same. Map out a plan before you find yourself feeling fully disconnected and isolated. By anticipating feelings of loneliness--either your own or of someone else (even a stranger)--you'll be better equipped to face them." If your mind is stuck in dark rut, call for free help at the national hotline: 1-800-273-8255.
"A mindful leader embodies leadership presence by cultivating focus, clarity, creativity, and compassion in the service of others....You can learn to lead with excellence by cultivating your innate capabilities to focus on what is important, to see more clearly what is presenting itself, to foster greater creativity, and to embody compassion....These choices often lead to a win-win-win scenario: good for the organization, good for the employees, and good for the community."
"It is also true, though, that these tumultuous times can offer great opportunity and ample possibilities for innovation, as the world becomes smaller and we begin to see the potential to meet the complexities of the day in ways that are truly creative, productive, and compassionate. It's a time to take leadership, and to redefine what it means to lead with excellence."
"Just as a pebble thrown into a still pond can create ripples spreading throughout the whole of the pond, so too can the cultivation of leadership presence go far beyond the effect it has on us alone."
"Taking note of the qualities exhibited by leaders we admire can help all of us pinpoint how to become better leaders ourselves."
"If we see the impact that mindfulness has on safety and on outcomes for patients in reducing health care errors, how can we not start...looking at this as real way that we can improve the quality of work?"
