The low risk and high return of integrative health services.

Supplemental treatments and practices such as yoga, acupuncture, guided imagery, and meditation can benefit not only patients in their recovery but also hospitals and health systems financially and operationally. Benefits include: > Savings in sedation costs for patients who use guided imagery during procedures > Increased revenue due to measurably increased patient satisfaction > Decreased length of stay.

Improving physician clinical documentation quality: evaluating two self-efficacy-based training programs.

BACKGROUND: Clinical documentation is critical to health care quality and cost. The generally poor quality of such documentation has been well recognized, yet medical students, residents, and physicians receive little or no training in it. When clinical documentation quality (CDQ) training for residents and/or physicians is provided, it excludes key constructs of self-efficacy: vicarious learning (e.g., peer demonstration) and mastery (i.e., practice). CDQ training that incorporates these key self-efficacy constructs is more resource intensive. If such training could be shown to be more effective at enhancing clinician performance, it would support the investment of the additional resources required by health care systems and residency training programs. PURPOSES: The aim of this study was to test the impact of CDQ training on clinician self-efficacy and performance and the relative efficacy of intervention designs employing two versus all four self-efficacy constructs. METHODOLOGY/APPROACH: Ninety-one internal medicine residents at a major academic medical center in the northeastern United States were assigned to one of two self-efficacy-based training groups or a control group, with CDQ and clinical documentation self-efficacy measured before and after the interventions. A structural equation model (AMOS) allowed for testing the six hypotheses in the context of the whole study, and findings were cross-validated using traditional regression. FINDINGS: Although both interventions increased CDQ, the training designed to include all four self-efficacy constructs had a significantly greater impact on improving CDQ. It also increased self-efficacy. PRACTICE IMPLICATIONS: CDQ may be significantly improved and sustained by (a) training physicians in clinical documentation and (b) employing all four self-efficacy constructs in such training designs.

Conventional Practitioners' Communication of Integrative Alternatives for Chronic Back Pain: An Evidence-based, Patient-centered Model.

Chronic back pain is one of the most common conditions treated in the United States. Informed consent is the communication of treatment alternatives, benefits, and risks and must be provided to patients in most instances. The alternatives provided during this discussion should include all options supported by research evidence and the patient's preferences. This article proposes a model for chronic back pain that includes the communication of complementary therapies as part of a patient-centered, integrative approach to informed consent. The content of informed consent is determined by common law (court cases), legislation, regulations, and evidence-based research. The practitioner's and patient's knowledge and the patient's values should be used to filter this information. Finally, shared decision making should be used to arrive at the patient's final decision regarding informed consent for treatment.