Some like to refer to major change agents in the integrative health field as “rock stars.” To the extent that this applies, a key leader of real world integrative health research, Jeffery Dusek, PhD and the chief cat herder in the universe of professional acupuncturists, David Miller, MD, LAc, belong on album covers. These images come to mind as Francoise Adan, MD, the director of the University Hospitals Connor Integrative Health Network (CIHN) has attracted each to work there. The “Connor” in the name of the system-wide integrative model refers to a philanthropic couple who also happen to be generous donors to the Rock n’ Roll Hall of Fame and Museum. I called Adan and her two colleagues to find out more about what their visions are as these front-men join the CIHN band.
The origin story of Christopher and Sara Connor’s philanthropy is a familiar one at integrative centers: initial interest is from the spouse of a wealthy businessman who has an interest in new forms and philosophies of care. “The initial passion came from Sara who trained as an occupational therapist,” recalls Adan, “but Chris quickly became CIHN’s biggest champion. They’ve been incredibly generous with their philanthropy, their support, their guidance and their love. They have changed my life and have impacted the lives of many.” Adan adds:
Chris has infused some great leadership principles into our team that we often refer to: united (locked arm/teamwork), hard work, humility and goal setting. At Connor, we operate as a team. Everyone has an important role to play, we build on each other’s strengths and talents, and we know we have a purpose.
To date, the Connors have donated over $8.5M to CIHN and have, according to Adan, “inspired many gifts from other generous donors.”
Growth of the Connor Network
The Network was founded in 2011. Adan recalls that back then, it was just her and two part-time clinicians. Only a handful of physicians among the thousands in the huge system were referring patients for CIHN’s integrative services. One measure of success: a decade later, CIHN now counts 1800 physicians who have referred patients to integrative services. Other measures of the advance are on the website. Now 13 different therapies are offered from a growing multidisciplinary team.
Adan proudly shares the diversity of the current Connor clinical staff: six licensed acupuncturists, nine licensed massage therapists, four chiropractic physicians, two yoga instructors, two meditation and mindfulness practitioners, fifteen expressive arts therapists, and “four integrative medical doctors, each with unique training in integrative medicine specialties.” (One is certified through the original American Board of Integrative Holistic Medicine, a second via the American Board of Integrative Medicine, a third through the American College of Lifestyle Medicine and the fourth is an osteopathic physician who remains connected to osteopathy’s roots in manipulative therapies.)
The key to her hiring strategy, shares Adan, is that “no one is a diva – they are good at team work.” She underscores the importance of this priority: “The chemistry is crucial. The credentialing or board certification is not as important.” At roughly 10 years, CIHN – with its combination of a total of 62 clinical and administrative employees – provided more than 32,000 visits per year across 6 outpatient locations and 11 inpatient locations
Dusek: Influencing decision makers with real world research
The interview with Adan came on the heels of news that Dusek, as primary investigator for a multi-institutional team, has just been awarded a $2.0-million grant to study the value of acupuncture in emergency medicine. Adan wanted Dusek’s research expertise because his focus is not on reductive trials but on the health services research that will most quickly influence decision makers to enhance integrative offerings. Their focus is on influencing CIHN’s surrounding system and the care delivered elsewhere in U.S. medicine. Adan lauds the influence that the former research director of the Penny George Institute at Allina Health has brought to CIHN:
Jeff knows that having good testimonials is nothing unless we bring rigor and discipline to the way we document everything we do. Maybe you and I can communicate about what we are doing from the heart. Yet, knowing you are doing good work and that patients are liking it is not enough. To influence stakeholders, leaders, policy makers, and donors, you need outcomes. As one part of a large academic healthcare center, we are continuously trying to influence decision makers. Jeff is getting our providers to document the results of the visits. Colleagues in IT have been generous to us in helping build new templates to be able to extract the data from the medical record. We’ve had a transition in mindset. He’s helping us to develop the language we need to communicate in those environments.”
Dusek has been at CIHN for two years. When he references the Network’s data context of 20,000 outpatient visits and 12,000 inpatient visits, he sounds a bit like a prospector hitting the mother-load. The hospital’s core inpatient program is the delivery of multiple music therapies including active music making with patients. Each music therapist has a cart of musical instruments. Another option is the development of personalized playlists for patients. Dusek shares that “the medical staff also really appreciate the music for their personal benefit.”
With funding from the Cleveland’s Kulas foundation, Dusek and Seneca Block, MA, MT-BC, CIHN manager of expressive therapies, are currently mining the electronic medical record data from 2017-2020 for all music therapy sessions across 11 UH hospitals. He commented:
We have some early signals that music therapy is providing reliable pain relief. And, since Francis Collins (head of NIH) is very interested in music therapy as an intervention, we are planning to use these results to propose new trials for possible NIH funding.
Another inpatient program is centered in orthopedic surgery. Dusek shared that “one of the system’s lead orthopedic surgeons shares an interest that has led to a project on acupuncture post-joint replacement for hospitalized patient.” Collaborative work is being done with CIHN’s acupuncture lead Christine Kaiser, MS, DACM, LAc. Adds Dusek: “We’re seeing some nice improvements in pain and anxiety in that population.”
In the outpatient environment, patient charts now include pre-treatment and post-treatment responses on pain, anxiety and stress. “Our goal is to get the right therapy, to the right patient, with the right dose, at the right time.” Dusek is not comfortable with the solely limited snapshot of pre-post treatment data. “My goal is to engage the patient in helping us understand outcomes after they leave the hospital or the clinic as well,” he notes. Dusek is a strong advocate of patient-centered research as promoted by the Patient Centered Outcomes Research Institute (PCORI). “Data should not be provided via a one-way street from patient to researcher. It’s very important to give it back to the patient.”
Ironically, PCORI turned down earlier versions of the acupuncture in the E.R. project. Now funded via the NIH, Dusek will be running that project through the Bravenet practice-based research network. Adan provided a statement from CIHN on the project (later published in this media release):
“Dr. Jeffery Dusek, Director of Research for the University Hospitals’ Connor Integrative Health Network, and colleagues were recently awarded a 3-year, $2+ million grant from the National Center for Complementary and Integrative Health at the National Institutes of Health. Dr. Dusek and Dr. Diane McKee will co-lead a multi-center study of acupuncture being provided in the Emergency Department to manage pain, and ideally reduce exposure to opioid medications. This study will leverage the BraveNet Practice Based Research Network, which is a leading group of 15 integrative medicine clinics across the US. …Positive results from this study and a future large-scale study could provide critical evidence to support inclusion of acupuncture in Emergency Departments nationally. If successful, such an expansion could provide Americans with additional non-pharmacologic methods for robust pain management, and ideally reduce patients’ opioid use.”
Miller: Political organizer under his clinician-researcher hat
Integrative pediatrician David Miller, MD, LAc is the rare medical doctor who has also completed a full course in acupuncture education that allows a professional to sit for acupuncture licensing. Over the past decade, Miller parlayed the dual respect that granted him with a remarkable commitment to advance acupuncture into the first successful effort in 30 years to create an organization that has essentially united the licensed acupuncture profession. For observers, Miller’s strategy of building the American Society of Acupuncturists up through the network of state professional associations was nothing short of brilliant. Why did Adan go out and get him?
Our team knew David through his work with the Integrative Health Policy Consortium. We had a national search. When I met him, I knew this was our guy. He arrived here March 2 – just before COVID hit. Still, in 6 months and despite COVID, he’s done so much – grand rounds, media, raising money, seeing patients, working on research ideas with Jeff. They have in common that they are both humble – and both tenacious. They’re not afraid of pushing, pushing, pushing something until it works.
“I was born in Cleveland,” said Miller, explaining some of the comfort in his move from Chicago for the CIHN position. He also was comfortable in the institutional environment through his past work as a hospitalist before he chose to go to a college in acupuncture and Chinese medicine. The scope of the University Hospitals-CIHN opportunity grabbed him:
It offered the possibility of having a blank slate [in integrative pediatrics]. It was multi-faceted – inpatient and outpatient. They were open to letting me start something robust. We’re going to be treating the staff that’s treating the kids as well as treating the kids themselves. My first steps were to get to know the hospital as if it were a new patient. I needed to know the culture, the people, the environment. It’s been great. The hospital is welcoming. Top leadership is not just interested – they are excited! We don’t have to argue or sell anything.
Miller notes that the hospital presently has some acupuncture and massage in hematology-oncology. He alludes happily to the new study on which Dusek is funded through which there will be new attention on use of acupuncture in the emergency room. Dusek says he and Miller are discussing some other possible studies like “studying kids with Type 2 diabetes and depression.” Another area of focus is pediatric idiopathic abdominal pain. Their current work is funded by Cleveland’s Prentiss Foundation. They plan to start with a single group pilot trial and move, if they have positive results, toward a randomized controlled trial to be submitted to the NIH.
I asked Adan to list any external factors that have positively influenced CIHN’s trajectory inside the larger medical delivery organization. She quickly ticked off these:
The Joint Commission’s action on pain guidelines, of course. The ACP [American College of Physicians] pain guidelines have also been powerful. Being part of the Consortium [Academic Consortium for Integrative Medicine and Health] has helped validate and elevate our program. As the current Consortium Chair, it’s not only colleagues and resources but also friends. I’ve given a lot of time to the Consortium, but I have received more than I give. Medicare and Medicaid making changes in covering acupuncture have been important. The VA [Veterans Administration] – if people think we are only talking about soft medicine for wealthy people we have a problem. The VA gets their attention. The opiate crisis also has been a factor. It has been forcing people to look at non-pharma. Even the pandemic has made positive differences. It has provided a platform to accelerate telehealth and patient-access and also increased interest in well-being awareness, and in the importance of risk factors in mortality.
Adan described another breakthrough opportunity the pandemic has brought to her program: “Every day since April 4, every member of the community gets a well-being tip from us. It has the record for opened emails.” The 28,000 employees also get access to a digital resource library developed by CIHN to help them find and sustain their well-being.
Employee services and community goals
The COVID-era wellness tips fit with a CIHN strategy that has characterized and supported their “horizontal” approach advertised by the “network” concept in their name. The goal is to reach as broadly as possible into multiple University Health departments and facilities rather than to function in a service silo. The strategic focus on providing benefits to employees is well aligned with this strategy. The benefits of the focus rebound to the parent system:
Our program increases the loyalty of employees. It brings people in when they are young. It brings women, and they are the decision makers on health usually. We are self-insured and we have data on pain and anxiety that shows the positive outcomes. The system is hiring 170 new nurses and we were asked to design an 8 week program to assist with their transition. People see us as part of the solution. Can we cure cancer? We can help with cancer. Can we cure employee retention? We can probably help a lot.
The goal is global, and more ambitions. University Hospitals, affiliated with Case Western Reserve University, is a regional medical organization focused of providing care of people in Northeast Ohio. Adds Adan:
From the get-go, our goal has been to transform healthcare and to weave evidence-based modalities into everything we do for our patients, for employees, and for the community, to enhance clinical outcomes, patient experience, and cost savings. We’re trying to eliminate the sense of separateness between integrative health and regular medicine. By 2030, we will not talk about integrative medicine. We will simply talk about good medicine.”
In the midst of writing this article, I received a query from a colleague who is a past president of the American Holistic Medical Association (AHMA) – now merged into the Academy of Integrative Health and Medicine. He had a skepticism that is typical of many community holistic and integrative practitioners who have witnessed how institutional integration processes can box, limit and isolate integrative services. The former AHMA president wanted, as he asked in the email, my “thoughts on the top few medical schools/institutions that really support integrative medicine or have legit programs.”
Legit? How does one measure that? In a system with 18 hospitals and 28,000 employees – CIHN’s current practitioner team is clearly too a small to provide integrative services far and wide. That some integrative services are offered in 11 inpatient sites is notable – yet the fact that such services are mainly music therapy takes away some of the sheen. The daily well-being messages that reach everyone may perk up curiosity in employees about what else CIHN may have to offer. Those inspired by these virtual Trojan horses for integrative care can then plug “integrative health” into the system’s website. They will see a solid set of 10 results pop up. Meantime, a “Message to Our Patients about Coronavirus” doesn’t explicitly call out the CIHN services, nor does a Taking Care of Your Health page link to CIHN as the content directly links to some other departments.
CIHN is at roughly the midpoint from Adan’s arrival at CIHN to the 2030 period when she projects integrative health will be layered into “everything we do” at University Health. I’d say to my inquiring colleague that Connor Integrative Health Network is indeed on a “legit” path. Then I’d call attention to the fact that right now Adan is busy signing deals with the right band members so that the integrative health rocking and rolling can begin in earnest.