Relevance of Quality Measurement to Integrative Healthcare in the United States.

With the advent of new models for payment and delivery of healthcare services, the use of quality measures for continual improvement of clinical healthcare is now an integral feature of medical practice in the United States. However, quality measurement and quality improvement activities are not common practice among integrative health providers. This article discusses the import and application of quality measurement to the practice of integrative healthcare. It reviews developments in the healthcare quality improvement movement, explores the relevance of quality measures to integrative healthcare, describes examples of the current use of quality measures in integrative health practice, discusses discriminatory policies that may prevent participation in quality improvement by integrative health practitioners, and makes recommendations for practice and policy.

Incorporating Yoga Therapy into Primary Care: The Casey Health Institute.

Individuals seek complementary and alternative medicine (CAM) for a variety of health conditions, and yoga is a popular CAM modality. Over the past few decades, yoga has become incorporated into hundreds of healthcare facilities, most commonly in large university medical centers. While research has shown yoga to be effective in reducing symptoms and improving outcomes in chronic health conditions, most patients seek yoga therapy on their own, as few primary care practitioners have incorporated yoga therapy into their practices. The purpose of this article is to describe the efforts of the Casey Health Institute to incorporate yoga therapy into their primary care integrative medicine center. At Casey Health, a full-time Clinical Yoga Specialist works alongside the physicians, nurses, and CAM providers in delivering care to a wide variety of patients. The majority of referrals to yoga therapy have been for pain-related musculoskeletal conditions, as well as hypertension, headaches, anxiety, depression, and sleep disturbances. Most patients attend weekly 60-minute individual sessions, and the Clinical Yoga Specialist stays in touch with the patient between appointments via telephone and email. T h e Clinical Yoga Specialist has become an integral part of Casey Health, participating in collaborative medical appointments in which two CAM practitioners provide simultaneous treatments to a patient. She also participates in the clinic's ongoing weight loss program. The Clinical Yoga Specialist spends one morning each week "floating" in the clinic, when she is on-call to the practitioners to assist in treatment and/or to introduce a yoga therapy experience to the patients. These brief interventions introduce the patients to the therapeutic benefits of yoga, while simultaneously demonstrating yoga's effectiveness to the healthcare providers. Casey Health has developed a unique teacher training program whose faculty includes senior Iyengar yoga teachers as well as physicians and CAM practitioners. Casey Health is incorporating clinical outcomes into their electronic medical record that can be used internally to assess comparable effectiveness and cost effectiveness of the different treatment modalities such as yoga therapy, providing evidence that eventually may lead to yoga therapy becoming an accepted treatment that is eligible for insurance reimbursement.