Abstract ID: 2255

Primary Topic: Integrative medicine delivery models
Secondary Topic: Curriculum design and development

Integrative East-West Medicine in the Academic Health Center Setting: The UCLA Experience
Justin G Laube, MD; Edward Hui, MD; Andrew Shubov, Medicine ; Ka-Kit Hui, MD; Lariza Johnson, MPA; Sandi Chiu, MSOM, LAc, , Los Angeles, CA, United States

Late Breaker: No

Overview

When a group of UCLA resident physicians were given an introductory talk about integrative medicine (IM), their response was “…isn’t that East-West medicine?”  The Center for East-West Medicine (CEWM) is an academic clinical program within the UCLA Department of Medicine that is ingrained into the fabric of UCLA Health, an integrated health system in southern California.  CEWM was founded in 1993 by Ka-Kit Hui, MD, FACP, the current medical director, to blend the healing traditions of traditional Chinese medicine (TCM) with western medicine.  CEWM includes 4 clinics in Los Angeles county providing ~25,000 patient visits per year by a clinical team comprised of 8.75 FTE faculty, 3 fellows and 12 clinical specialists (LAc, CMTs).  Patients are primarily referred from >500 primary care providers and specialists from within UCLA Health for a variety of refractory conditions (e.g. fibromyalgia, IBS, chronic headaches).

CEWM utilizes a consultative clinical model based on a biopsychosocial framework that incorporates aspects of person-centered medicine, TCM, IM, generalist problem solving and interprofessional teamwork.  Patients are seen by physicians with fellowship training in East-West Medicine and our clinical specialist team.  Revenue is generated primarily through insurance reimbursement.  The clinical program added a primary care arm in 2013 and will launch an inpatient consult service this year.  There are a variety of educational programs including a visiting scholar exchange program with China, medical student electives, resident rotations and an advanced-physician ABoIM-recognized fellowship.

This session will provide an in-depth view of the CEWM clinical model.  We will use patient cases to guide participants through a typical patient experience at CEWM.  Our management team will discuss the financial model, including experiences with expanding the program and suggestions for other clinics.  We will present curricular examples from our international, fellowship and medical student educational programs.

Rationale

This topic is important given the current challenging insurance environment and recent closure of many IM ambulatory clinics nationally.  CEWM has survived 24 years and other IM center leaders may benefit from learning from our experiences, challenges, and triumphs during this time.  CEWM is also an unconventional IM clinic with emphasis on integrating a single alternative health system as its core mission, and this model may be useful for other programs looking to start IM programs.

CEWM is a strong example of “collaboration in action” through its consultative care clinical model, growing East-West primary care program, new inpatient program, and international exchange program with China.

CEWM clinic visits include a customized treatment plan that involves collaboration between patient, physician and clinical specialist (comprised of TCM practitioners and integrative manual therapists).  For example, patients see the clinical specialist and then their physician consultant at each follow-up visit to co-progress their care plan.  Physicians and clinical specialists are “bi-lingually” trained in discussing patient care conditions in TCM and western medicine nomenclatures and care philosophies.  Each practice according to their own expertise and work together to co-manage the patients care as a team.  Treatment plans often include a variety of simultaneous therapies that may include acupuncture, cupping, tui na, myofascial release, and trigger point injections.  Patients are actively engaged to create a self-care plan that might include integrative East-West nutritional guidance (based on modern nutritional and TCM diagnostic recommendations), flexibility and postural exercises, acupressure and self-massage, medication risk reduction guidance, and pertinent referral to various therapies (aquatic and land physical and occupational therapy), sleep medicine, weight loss management, mindfulness training) both at UCLA and in the local community.

CEWM is expanding further to encourage collaboration and integration in the UCLA Health system.  The East-West Primary Care program was created in 2013 for patients seeking care from more open-minded integrative generalists (who are also CEWM consultants part time) and to have access to the consultative clinic and care philosophy.  This creates a fluid collaborative environment between our primary care and consultative treating clinical specialists.  The East-West Inpatient Consult service will formally launch in 2018 and allow full-time East-West hospitalists to collaborate with inpatient medical providers to help patients with challenging symptoms and potentially reduce hospital length of stay. 

Finally, CEWM is leading the way to foster an exchange of expertise between IM in the US and China.  CEWM hosts visiting scholars and cohorts of health professionals from China to be immersed in our educational and clinical programs and to share their expertise and research with our Centers staff and faculty.  This cultural and knowledge exchange is the heart of our clinical fellowship and health trainee educational programs.  E.g. a fellow will be taught by a TCM expert, with a PhD and LAc degrees, as well as an integrative East-West faculty at the same session. 

Objectives

  • Learn about an integrative medicine clinical delivery model that is ~25 years old and deeply ingrained into the culture of an academic health system.
  • Consider the integration of a specific alternative medicine system with western medicine as an alternative to other integrative medicine “quarterback” models.
  • Identify the potential of incorporating trigger point injections and myofascial release with TCM therapies such as acupuncture, cupping, tui na.
  • Experience examples of TCM inspired self-care techniques, including self-acupressure, that are taught to patients in our clinic.
  • Recognize how the model is financially sustainable and incorporates insurance payments to achieve this state.
  • Identify the challenges and triumphs in growing an integrative medicine program within an academic health system.

Methods/Session Format

  • See the outline for the designated time per element.
  • The format will include:
    • Case-based learning examples to introduce the clinical care model.
      • Session will be interactive and include small groups.
    • Audio-Visual tour of the patient experience from check-in to conclusion of the visit.
    • Our clinical team will present the remaining topics through PowerPoint didactics with open opportunity for questions and answers from the audience in real time.
    • Final portion will be a Q & A section with both written and open mic questions.

Outline

  • Introduction to CEWM and the care delivery model. (25 min)
    • Clinic history with emphasis on the development from idea to creation of the clinic.
      • Key allies who supported the clinic and pivotal lessons learned during its growth.
    • Ambulatory case-based learning examples.
    • Visual presentation of a patient’s experience at clinic including the health history questionnaire, clinic environment, treatment experience, and self-care homework examples.
    • Examples of EMR integration (including e.g. Epic health system acupoint quick tabs).
    • Self-care example with the audience: self-acupressure for common conditions and presentation of other patient handouts.
    • Examples from our clinic to emphasize the role of a supportive workplace culture that values interprofessional teamwork.
  • Business and Financial operation. (15 min)
    • Experiences with insurance and billing in the ambulatory setting for IM care.
    • Experiences with coverage for different IM treatments and visit types.
    • Tools to optimize length of visits.
  • Experiences with creating an integrative East-West primary care home within an established consultative care clinic. (10 min)
  • Experiences developing collaborative local and international educational programs and curriculum. (10 min)
  • Take away points and open Q & A session. (10-15 min)