The Institute of Medicine today released its long awaited report on the Summit on Integrative Medicine and Health of the Public that was held in Washington in February of 2009. While this report does not contain action steps for the IOM itself, it is a very thorough account of the sentiments expressed by the leaders of the nation’s integrative health community during that auspicious three day conference.
The Summit was co-produced by the Bravewell Collaborative, which is holding a dinner in Washington this evening to mark the report’s release. Bravewell CEO Christy Mack said in a statement released today, “We have to start valuing and paying for health,” which is a sentiment that was powerfully demonstrated in the stories and presentations heard at the Summit.
The IOM report’s executive summary highlights many of the important themes that emerged from those presentations. Here is a summary of them (links to the sites and documents at the end of this article), while I plunge into the full 245-page report itself:
Vision of Optimal Health
Integrative medicine, or integrative health care, seeks the alignment of individuals and their health care for optimal health and healing across the life span.
A care process in which patients and caregivers work together to foster seamless engagement of the full range of health factors — physical, psychological, social, preventive and therapeutic — known to be effective and necessary to achieve optimal lifelong health
The perspective of integrative health care starts as early as before birth, to plan and shape a person’s health future. It is personal, predictive, preventive and participatory.
Patients are partners in addressing the different biological, psychological, spiritual and social and economic reference points that shape individual wellness, illness and healing.
Prevention and disease minimization represent the foundation of integrative health care; they ensure that the full spectrum of prevention opportunities — clinical, behavioral, social and environmental — are available.
The patient is the center of a team that blends professionals with a wide spectrum of expertise and skills, plus diverse, interdisciplinary education and training into a set of core competencies.
Providing care as a seamless integration across caregivers and institutions is the fundamental organizational principle. Every aspect of system design should further the goal of integration: patient navigators, health coaches, care support tools, electronic health records, and payment systems pegged to patient outcomes. (The poorly understood Patient Health Record, PHR, should sit in a position of primacy in health IT planning. The integrated and individual-centered primacy of care envisioned here could influence the position of PHRs.- TW)
Person-center care is also relationship-centered care: integrated not only across organized caregiver sites, but across the relevant life dimensions. Integrated relationships embrace home, family, loved ones, and the community, and accounts for social and economic factors that affect health, including employee status, education, income, social networks and family support. (The relationships described here will be strengthened by increased adoption of social media, which is already speeding through the new patient-centric health enterprise. – TW)
Assumes the adoption of lessons that cross scientific disciplines and scientific processes that cross domains. The most important influences on health, for individuals and society, are not the factors at play within any single domain — genetics, behavior, social or economic circumstances, physical environment, health care — but instead are the dynamics and synergies across domains.
Research tends to examine these influences in isolation, which can distort interpretation of the results and hinder application of results. The most value will come from broader, system-level approaches and redesign of research strategies and methodologies. (This may be the most practically important element here, and it reflects efforts now under way to broaden the definition of what is acceptable as “evidence.” – TW)
In addition to the best application of conventional allopathic approaches, it may use evidence-based interventions or practices derived from ancient folk practices, cultural-specific sources, contemporary product development, or crafted from a blend of these. Sound practice requires that the standards and evidence be appropriate to the modality assessed, consistent across the range of options and structured to assess broad outcomes over time.
Policies that encourage integrative health care would define value in terms that emphasize outcomes, elevate patient insights, account for family and social factors encourage team care, provide supportive follow-up and contribute to the learning process.
I noted several other themes while attending the event, notably how integrative care should be made part of medical education. And while in many ways the themes above reflect fairly widespread sentiment, they remain a wish-list, albeit an important one. Some of these principles have found their way into iterations of the health care legislation, for instance.
Institute of Medicine Report Summary (and order/download) Page
Bravewell Collaborative page on the Summit