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Grass F, Berna C, Vogel CA, Demartines N, Agri F. Complementary and integrative medicine - Resolving situations of reduced remuneration for additional work under the SwissDRG system. Heliyon 2024; 10:e34732. [PMID: 39157326 PMCID: PMC11328068 DOI: 10.1016/j.heliyon.2024.e34732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 06/26/2024] [Accepted: 07/16/2024] [Indexed: 08/20/2024] Open
Abstract
Aim of the study Complementary and integrative medicine (CIM) has been increasingly recognized as offering promising treatment adjunctions in various clinical settings, even amongst patients with serious, chronic, or recurrent illness. Today, only few tertiary care facilities in Switzerland offer dedicated CIM services for inpatients. The aim of the present study was to evaluate whether CIM services for complex medical conditions are adequately valued by the national inpatient SwissDRG reimbursement system. Methods A simulation was performed by adding a specific code of the Swiss classification of interventions (CHOP) to the list of codes of each patient who received CIM therapies at the Lausanne University Hospital (CHUV) in 2021. This code is to be used when CIM services are provided. Hitherto, it was not entered due to a lack of specific documents justifying the resources used. The analysis focused on the impact of adding this CIM CHOP code on the Swiss Diagnosis Related Group (DRG) reimbursement. Results In total, 275 patients received a CIM therapy in 2021. The addition of the CIM CHOP code 99.BC.12 (10-25 CIM sessions per stay) resulted in a simulated loss of income of CHF 766 630 for the hospital, while the net real result is already negative by more than CHF 6 million. The DRGs positively impacted by the addition of CIM CHOP code 99.BC.12 had a mean (SD) cost weight (CW) of 1.014 (0.620), while the DRGs negatively impacted had a mean (SD) CW of 3.97 (2.764) points. Conclusion It is necessary to quickly react and improve the incentives contained in the grouping algorithm of the prospective payment system, whose effects can threaten the provision of adequate medical care to the patients despite suitable indications and potential for cost-savings.
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Affiliation(s)
- Fabian Grass
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Chantal Berna
- Center for Integrative and Complementary Medicine, Division of Anesthesiology, Department of Interdisciplinary Centers, Lausanne University Hospital, Lausanne, Switzerland
| | - Charles-André Vogel
- Department of Administration and Finance, Lausanne University Hospital, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland
- General Direction, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Fabio Agri
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland
- Department of Administration and Finance, Lausanne University Hospital, Lausanne, Switzerland
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Veleber S, Cohen MR, Weitzman M, Maimon Y, Adamo CA, Siman J, Lu W, Sajdyk T, Stone JA. Characteristics and Challenges of Providing Acupuncture and Chinese Herbal Medicine in Oncology Treatment: Report of Survey Data and Experience of Five Unique Clinical Settings. Integr Cancer Ther 2024; 23:15347354241226640. [PMID: 38288552 PMCID: PMC10826404 DOI: 10.1177/15347354241226640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024] Open
Abstract
Acupuncture is an integrative therapy with strong evidence to support its use in the oncology setting, yet barriers exist for implementation into conventional medical clinics. Though acupuncture is recommended in clinical practice guidelines for oncology, there is little data in the literature showing how acupuncture and other related therapies, including herbal medicine are successfully implemented in some oncology clinics, while others experience barriers to care. To characterize the current use of acupuncture (ACU) and herbal medicine (HM) in oncology clinics, we collected general demographic and usage data from 5 example clinics. In addition, to better understand the barriers faced by ACU and HM clinics in implementing acupuncture as a treatment modality, a survey was deployed to 2320 members of the Society for Integrative Oncology. This article examines the characteristics of oncology settings around the world, and shares data from the survey on the use of these therapies in the field of oncology. The primary barrier to acupuncture care, as reported by providers, was cost. With just under 70% of the oncologists reporting it as the most important obstacle. Additional barriers to implementation included concerns about competency and training, accessibility and safety of herbal medicine during treatment. Though acupuncture is being incorporated into more conventional oncology settings, organized strategies for implementation involving payers and policymakers is needed.
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Affiliation(s)
| | | | | | - Yair Maimon
- Refuot Integrative Medical Center, Tel Aviv Israel
| | - Christine A. Adamo
- California Cancer Associates for Research and Excellence, San Diego, CA, USA
| | | | - Weidong Lu
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Tammy Sajdyk
- Indiana University School of Medicine, Bloomington, IN, USA
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Groninger H, Nemati D, Cates C, Jordan K, Kelemen A, Shipp G, Munk N. Massage Therapy for Hospitalized Patients Receiving Palliative Care: A Randomized Clinical Trial. J Pain Symptom Manage 2023; 65:428-441. [PMID: 36731805 DOI: 10.1016/j.jpainsymman.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 02/01/2023]
Abstract
CONTEXT Massage therapy is increasingly used in palliative settings to improve quality of life (QoL) and symptom burden; however, the optimal massage "dosage" remains unclear. OBJECTIVES To compare three massage dosing strategies among inpatients receiving palliative care consultation. METHODS At an urban academic hospital, we conducted a three-armed randomized trial examining three different doses of therapist-applied massage to test change in overall QoL and symptoms among hospitalized adult patients receiving palliative care consultation for any indication (Arm I: 10-min massage daily × 3 days; Arm II: 20-min massage daily × 3 days; Arm III: single 20-min massage). Primary outcome measure was single-item McGill QoL question. Secondary outcomes measured pain/symptoms, rating of peacefulness, and satisfaction with intervention. Data were collected at baseline, pre- and post-treatment, and one-day postlast treatment (follow-up). Repeated measure analysis of variance and paired t-test were used to determine significant differences. RESULTS Total n = 387 patients were 55.7 (±15.49) years old, mostly women (61.2%) and African-American (65.6%). All three arms demonstrated within-group improvement at follow-up for McGill QoL (all P < 0.05). No significant between-group differences were found. Finally, repeated measure analyses demonstrated time to predict immediate improvement in distress (P ≤ 0.003) and pain (P ≤ 0.02) for all study arms; however, only improvement in distress sustained at follow-up measurement in arms with three consecutive daily massages of 10 or 20 minutes. CONCLUSION Massage therapy in complex patients with advanced illness was beneficial beyond dosage. Findings support session length (10 or 20 minutes) was predictive of short-term improvements while treatment frequency (once or three consecutive days) predicted sustained improvement at follow-up.
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Affiliation(s)
- Hunter Groninger
- Georgetown University Medical Center/MedStar Health (H.G., A.K.) Washington, District of Columbia, USA.
| | - Donya Nemati
- Indiana University School of Health and Human Sciences (D.N., N.M.) Indianapolis, Indiana, USA; Department of Health Sciences (D.N., N.M.) Indianapolis, Indiana, USA
| | - Cal Cates
- Healwell (C.C., K.J.) Arlington, Virginia, USA
| | | | - Anne Kelemen
- Georgetown University Medical Center/MedStar Health (H.G., A.K.) Washington, District of Columbia, USA
| | - Gianna Shipp
- Virginia Commonwealth University School of Medicine (G.S.) Richmond, Virginia, USA
| | - Niki Munk
- Indiana University School of Health and Human Sciences (D.N., N.M.) Indianapolis, Indiana, USA; Department of Health Sciences (D.N., N.M.) Indianapolis, Indiana, USA; Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Massage & Myotherapy Australia Fellow and Visiting Faculty of Health, University of Technology Sydney (N.M.) Sydney, New South Wales, Australia; National Centre for Naturopathic Medicine, Southern Cross University (N.M.) East Lismore, New South Wales, Australia
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Ben-Arye E, Finkelstein A, Samuels N, Ben-Yehuda D, Schiff E, Reis S, Lesser L, Bergel M, Shaham D. From skepticism to openness: a qualitative narrative analysis of medical students' attitudes following an integrative medicine course. Support Care Cancer 2022; 30:4789-4795. [PMID: 35142910 PMCID: PMC9046550 DOI: 10.1007/s00520-022-06888-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/30/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The present study aimed to explore attitudes of medical students following a course in integrative medicine (IM) focused on palliative and supportive cancer. METHOD Attitudes to IM among pre-clerkship medical students were assessed following a 3-day required course, which included interviews with international experts in IM and "hands-on" workshops mentored by IM and non-IM healthcare professionals. Student reflections were analyzed qualitatively, and written narratives were examined thematically. RESULTS Of 161 students, 102 (63.4%) provided post-course reflections. The main narrative themes included pre-course attitudes, attitude changes and influencing factors, and insights on implementing IM in clinical practice. Pre-course attitudes were predominantly skeptical, with post-course attitudes more open and non-judgmental, addressing research on IM effectiveness and safety. Students looked favorably on the implementation of IM in clinical practice and felt the course enhanced communication with patients. CONCLUSIONS Student attitudes to IM shifted following the course, from a skeptical to a more non-judgmental and accepting approach. IM course may facilitate a better understanding of the limitations and risks of IM practices, particularly in the supportive cancer care setting, as well as implications regarding students' own resilience and professional growth.
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Affiliation(s)
- Eran Ben-Arye
- grid.6451.60000000121102151Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel ,grid.414553.20000 0004 0575 3597Integrative Oncology Program, Clalit Health Services, & Carmel Medical Centers, LinHaifa, Zebulun Israel
| | - Adi Finkelstein
- grid.419646.80000 0001 0040 8485Faculty of Life and Health Sciences, Jerusalem College of Technology, Jerusalem, Israel ,grid.9619.70000 0004 1937 0538Faculty of Medicine, Hadassah-Hebrew University Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Noah Samuels
- grid.414505.10000 0004 0631 3825Center for Integrative Complementary Medicine, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dina Ben-Yehuda
- grid.9619.70000 0004 1937 0538Faculty of Medicine, Hadassah-Hebrew University Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Elad Schiff
- grid.6451.60000000121102151Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel ,grid.414529.fDepartment of Internal Medicine & Integrative Medicine Service, Bnai Zion Medical Center, Haifa, Israel
| | - Shmuel Reis
- grid.9619.70000 0004 1937 0538Faculty of Medicine, Hadassah-Hebrew University Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lior Lesser
- grid.9619.70000 0004 1937 0538Faculty of Medicine, Hadassah-Hebrew University Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Bergel
- grid.9619.70000 0004 1937 0538Faculty of Medicine, Hadassah-Hebrew University Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dorith Shaham
- grid.9619.70000 0004 1937 0538Faculty of Medicine, Hadassah-Hebrew University Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
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Liu Y, Liu H. Utilization of Nursing Defect Management Evaluation and Deep Learning in Nursing Process Reengineering Optimization. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:8019385. [PMID: 34819992 PMCID: PMC8608515 DOI: 10.1155/2021/8019385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/23/2021] [Accepted: 10/15/2021] [Indexed: 11/21/2022]
Abstract
It was to explore the application of nursing defect management evaluation and deep learning in nursing process reengineering optimization. This study first selects the root cause analysis method to analyse the nursing defect management, then realizes the classification of data features according to the convolution neural network (CNN) in deep learning (DL) and uses the constructed training set and verification set to obtain the required plates and feature extraction. Based on statistical analysis and data mining, this study makes statistical analysis of nursing data from a macroperspective, improves Apriori algorithm through simulation, and analyses nursing data mining from a microperspective. The constructed deep learning model is used, CNN network training is conducted on the selected SVHN dataset, the required data types are classified, the data are analysed by using the improved Apriori algorithm, and nurses' knowledge of nursing process rules is investigated and analysed. The cognition of nursing staff on process optimization and their participation in training were analyzed, the defects in the nursing process were summarized, and the nursing process reengineering was analyzed. The results show that compared with Apriori algorithm, the running time difference of the improved Apriori algorithm is relatively small. With the increase of data recording times, the line trend of the improved algorithm gradually eases, the advantages gradually appear, and the efficiency of data processing is more obvious. The results showed that after the optimization of nursing process, the effect of long-term specialized nursing was significantly higher than that of long-term nursing. Health education was improved by 7.57%, clinical nursing was improved by 6.55%, ward management was improved by 9.85%, and service humanization was improved by 8.97%. In summary, the reoptimization of nursing process is conducive to reduce the defects in nursing. In the data analysis and rule generation based on deep learning network, the reoptimization of nursing process can provide reference for decision-making departments to improve long-term nursing, improve the quality and work efficiency of clinical nurses, and is worthy of clinical promotion.
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Affiliation(s)
- Yue Liu
- Rainbowfish Rehabilitation & Nursing School, Hangzhou Vocational & Technical College, Hangzhou, Zhejiang, China
| | - Huaping Liu
- School of Nursing, Peking Union Medical College, Beijing, China
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Dusek JA, Rivard RL, Griffin KH, Finch MD. Significant Pain Reduction in Hospitalized Patients Receiving Integrative Medicine Interventions by Clinical Population and Accounting for Pain Medication. J Altern Complement Med 2021; 27:S28-S36. [PMID: 33788611 DOI: 10.1089/acm.2021.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Prior research has reported that integrative medicine (IM) therapies reduce pain in inpatients, but without controlling for important variables. Here, the authors extend prior research by assessing pain reduction while accounting for each patient's pain medication status and clinical population. Methods: The initial data set consisted of 7,106 inpatient admissions, aged ≥18 years, between July 16, 2012, and December 15, 2014. Patients' electronic health records were used to obtain data on demographic, clinical measures, and pain medication status during IM. Results: The final data set included first IM therapies delivered during 3,635 admissions. Unadjusted average pre-IM pain was 5.33 (95% confidence interval [CI]: 5.26 to 5.41) and post-IM pain was 3.31 (95% CI: 3.23 to 3.40) on a 0-10 scale. Pain change adjusted for severity of illness, clinical population, sex, treatment, and pain medication status during IM was significant and clinically meaningful with an average reduction of -1.97 points (95% CI: -2.06 to -1.86) following IM. Adjusted average pain was reduced in all clinical populations, with largest and smallest pain reductions in maternity care (-2.34 points [95% CI: -2.56 to -2.14]) and orthopedic (-1.71 points [95% CI: -1.98 to -1.44]) populations. Pain medication status did not have a statistically significant association on pain change. Decreases were observed regardless of whether patients were taking narcotic medications and/or nonsteroidal anti-inflammatory drugs versus no pain medications. Conclusions: For the first time, inpatients receiving IM reported significant and clinically meaningful pain reductions during a first IM session while accounting for pain medications and across clinical populations. Future implementation research should be conducted to optimize identification/referral/delivery of IM therapies within hospitals. Clinical Trials.gov #NCT02190240.
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Affiliation(s)
- Jeffery A Dusek
- UH Connor Integrative Health Network, University Hospitals, Cleveland, OH, USA.,Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Rachael L Rivard
- UH Connor Integrative Health Network, University Hospitals, Cleveland, OH, USA.,Center for Evaluation and Survey Research, HealthPartners Institute, Minneapolis, MN, USA
| | - Kristen H Griffin
- Children's Minnesota Research Institute, Children's Minnesota, Minneapolis, MN, USA
| | - Michael D Finch
- Children's Minnesota Research Institute, Children's Minnesota, Minneapolis, MN, USA
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Hullender Rubin L, Veleber S. Hospital-Based Acupuncture Integration: Access, Reimbursement, and Implementation. J Altern Complement Med 2020; 26:356-359. [PMID: 32401620 DOI: 10.1089/acm.2020.0133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lee Hullender Rubin
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Susan Veleber
- Department of Integrative Oncology, Seattle Cancer Care Alliance, Seattle, WA, USA
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