Outcomes in Integrative Care That Will Intrigue Patients and Clinicians: from an ongoing series by

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Outcomes in Integrative Care That Will Intrigue Patients and Clinicians

The following is one in an ongoing series of columns entitled Integrator Blog by . View all columns in series

Summary: Bravo to Marja Verhoef, PhD and her team with the Canadian Interdisciplinary Network for Complementary and Alternative Medicine Research (IN-CAM)! On March 31, 2008, IN-CAM unveiled the IN-CAM Outcomes Database. The project, funded through the Lotte & John Hecht Memorial Foundation, brings together a huge set of instruments with which practitioners and researchers can explore their outcomes. While one might quibble with the non-inclusion of presenteeism and economic indicators, this database should become the center of the universe for the most productive research in complementary and integrative medicine. Ever wonder why it is leaders from Canada and not the United States who have taken the lead in this work?

View database: http://www.outcomesdatabase.org

Taking the lead in gathering useful outcomes instruments
On March 31, McGill University Health Centre Research Institute and University of Calgary announced the launch of the "first-ever searchable database of outcomes measures intended for complementary and alternative medicine researchers." Called the IN-CAM Outcomes Database, the project was led by Marja Verhoef, PhD, and a team organized through the Canadian Interdisciplinary Network for Complementary and Alternative Medicine Research (thus the IN-CAM in the title).

In a separate announcement of the opening of database at the 3rd International Congress on Complementary Medicine Research in Sydney, Australia, Verhoef and her team outlined the two key purposes:

Make practical information available on a wide range of outcome measures relevant to CAM research.
To organize and categorize outcome measures within a unique Framework of Outcome Domains that integrates measurable domains of health into a unified scheme.

Funding came through IN-CAM and the Lotte & John Hecht Memorial Foundation. The Canadian-British team which led the work included Verhoef, Mark Ware, MD, MSc, Trish Dryden, RMT, MEd, Charlotte Paterson, MSc, PhD, MBChB, MRCGP, Laura Weeks, BSc, Ania Kania, RMT, BSc, Linda Ferguson, Devon Mallory, and Patrick Gignac, PhD. They were advised by a team which included two scientists from the University of Arizona School of Medicine, Iris Bell, MD, PhD, and Cheryl Ritenbaugh, PhD, MPH. The announcement from McGill of this historic moment in the short history of CAM research is printed in full, beneath the comments, below.

Marja Verhoef, PhD, team leader in the project
Comment: This is very important work. I urge all of you, practitioners even more than researchers, to go, visit and enjoy this cornucopia of outcomes tools. If the goal of research education for complementary and integrative medicine practitioners is to engage and excite them, this database should become the center of practitioner training. These tools mirror practices and experiences of clinicians. Rather than alienate and estrange with the deification of the large, single agent, randomized controlled trial which panders to pharmaceutical medicine and teach practitioners that research is not for them, many of these tools invite imagination, application and incorporation. IN-CAM and the NIH National Center for Complementary and Alternative Medicine (NCCAM), for that matter, would do a service to begin partnering with professional associations, councils of colleges and other academic organizations in the CAM fields to develop presentations on the database at conferences and meetings.

My only gripe - which I expressed to Verhoef and reported in a prior Integrator article while the project was in development - was the decision not to include economic instruments. If one is interested in measuring impacts of a whole system, as Verhoef and her team are, aren't economics always part of such a system? The site does include functionality measures, which begin to get at the kind of data that employers and other healthcare purchasers need to see. Yet in my quick skim through the alphabetized set of instruments, I saw nothing on presenteeism, for instance. Neither the Work Limitations Questionnaire (WLQ) developed by Debra Lerner, PhD or the Stanford Presenteeism Scale, developed by Integrator adviser Kenneth R. Pelletier, PhD, MD (hc) were represented. Such measures may be the optimal, practical (by that I mean, system changing) outcomes for making the case to employers for the value of whole practices. The good news is that the IN-CAM Outcomes Database includes a place to "Suggest an Outcomes Measure."

Why Was this Initiative Not Born in the United States?

Finally, a reflection and assertion. Is it not interesting that, here, south of the Canadian border, despite $1-billion having been spent by NCCAM on "CAM" research, that such a critically important initiative was engaged outside of our borders? How can we explain this?

I have a couple of thoughts. I invite yours. One is that Verhoef and her team define themselves by asserting their "inter-disciplinary" nature. Their home is within, and across disciplines, rather than inside an MD-dominated universe. Those disciplines which are not exponents of a biomedicine uber alles way of thinking are more likely to prioritize patient-centered outcomes over reductive measure of efficacy. Second, both Canada and England - from which the leadership of this initiative has arisen - have government-funded, universal healthcare. I postulate that when government is more involved in healthcare delivery and payment, it is more likely to focus on practical outcomes.

My thesis here is affirmed by an anecdote from the recently concluded conference of large employers in which Philip Hagen, MD, a worksite health promotion leader, spoke on employee-related initiatives at Mayo Clinic. A member of the audience asked Hagen why hospitals and health systems have tended to be slow, as employers, to develop significant wellness programs for their employees. After a moment, Hagen responded directly: "I think it's because of our tendency in hospitals to believe in biomedicine for everything."

With this database, IN-CAM asserts the importance of the rest of the biopsychosocial model - a fine fit for the wholism of integrative and complementary and alternative health care.

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IN-CAM Outcomes Database: Collaborative Research Database To Benefit Complementary And Alternative Medicine

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