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Blend of Care at Hospital Improves Patients

In 2009, with great wisdom and funding from designer Donna Karan, two doctors and their colleagues from Beth Israel Hospital formed a plan of collaboration. They brought holistic medicine into a cancer ward. While offering these additional healing methods, they measured patient satisfaction and cost effectiveness too. It was a big hit.

Led by Dr. Woodson Merrell and research director Dr. Ben Kligler, the "Urban Zen Project" has become the model to replicate when looking for ways to combine western medicine with complementary therapies.

The findings are in!

"There are other studies but this is the first one we know of that combines an in-hospital study that looks not only at the patient experience but also at costs as well," says Dr. Merrell.

"Increasingly reimbursement is going to be partly tied into patient satisfaction, even with Medicare," he continues. "So you can show that there's a significant difference in patient satisfaction and quality of life, as they experience their hospital care with the add-in holistic approaches. It should hopefully give more credibility for hospitals that are looking for guidance in ways to improve the patient experience and outcomes."

Dr. Merrell encouraged me to also talk with Dr. Ben Kligler, who was the P.I. on the study (Primary Investigator). So I asked Ben to start by revealing some basics.

"There were 5 components," he explains.

1) The Yoga Therapists.
2) The Patient Navigator (to guide, explain and help manage).
3) The physical space - there was a renovation of some of the floor.
4) A holistic nursing training program that all the nursing staff went through, so they could learn how to do aromatherapy and visualization, and incorporate it into all their work with patients.
5) Yoga DVDs so that patents could watch the yoga tapes while they were there if they wanted to.

Lese Dunton: I heard the first part of your study, involving patient satisfaction, is going to be published soon.

Dr. Ben Kligler Yes, it's due to be published in The Journal of Complementary and Alternative Medicine in June, 2011. Some of the findings already got presented it at The Society of Integrative Oncology meeting in November 2010.

Basically what we found was that patients had significantly less anxiety. They had less depression. They had more energy and they had less pain overall than people who were there before Urban Zen was in place. That was the primary thing that we found.

We also found that people in the Urban Zen group needed less medication for nausea and less medication for sleep and anxiety than people who were there before the Urban Zen Project was available.

We looked at several things. We looked at something called, "The Profile of Mood States." It's a 30-item questionnaire that measures things like anxiety, depression, and energy level. It's used in lots of studies to kind of take a snapshot of how people are doing psychologically, basically. That was the main measure we used.

We collected data on a group of 89 people who were on the floor. A group of patients who were admitted to 9 Dazian, which was that particular floor, during a 6-month period of time before the Urban Zen Project came into implementation.

We gathered the data on those people and then we compared it to a group of 74 people who were on the floor after the Urban Zen Project was available. So the Yoga Therapists were there and the Patient Navigator was there, so they could get access to all those things.

LD: That's great. Does that bode well for proving that this saves money?

BK: Hopefully. That's the idea. That part has not gotten accepted for publication yet. The cost part. That isn't in the article that's coming out in June, so that one I need to be real general about.

The reason we collected data on costs was that ultimately you have to be able to convince hospitals that this is a good business move. So if you can show them on any hospitalization, you saved whatever - X dollars in medication costs, then they're going to say okay well maybe it is worth paying for the yoga therapists, or paying for whatever. So that's why we felt it was important to collect data about costs.

LD: Do you know when the second part of the study, with the cost saving results, will be released?

BK: We're just getting that submitted, so that's a process. I don't know exactly when that's going to be published.

LD: I'm always hoping that someday all this might be covered by insurance, but in the meantime it at least might prove that this is a cost-saving patient-improving method that's really, really important and worth doing.

BK: Right. In a perfect world, if you could just show that people have a better experience, a less painful experience, a less anxiety-producing experience, then maybe society should feel that that's the right thing to try to provide that for them.

It is challenging because hospitals are always up against the bottom line and so that's kind of why we think it's important.

There are two ways you could argue it. You could say, "If a hospital offers these things to patents, then hopefully that will attract more business to the hospital and in the long run that will make it more worthwhile."

Or, you could say, "Well, do these things save the hospital money, on any individual hospitalization?" And if you can show that, then that's really good stuff.

LD: So healing-hastening and money-saving in one.

BK: Exactly. That would be the perfect world. The challenge is that cost studies are very hard to do. A lot of the costs are not that easy to capture. You can say: how long did they stay in the hospital? How much medication did they use? But, did it change the cost after they went home? How many had to see their doctor more because of more pain or more nausea after they went home, but meanwhile maybe if they got the yoga therapy they didn't have it...it's very had to access that information.

So really cost studies are challenging and expensive. They're hard to do. So we're doing our best to find these sort of proxy measures or approximate measures of costs.

LD: I feel like someday this will all be natural and everyday; everybody will be doing it.

BK: Yes, hopefully!

LD: It's great that you're setting an example, a model that can be replicated.

BK: The other idea is just to show that it can be done. That you can get hospitals to accept it. That the staff is motivated, that the patients like it.

Also in our studies we conducted, "Qualitative Interviews," where we did a structured 15-minute interview with not all the patients, but a sub-group of patients. We asked them to tell us about their experience and what they thought of the yoga and this and that.

It's what's called a "Mixed Methods Study," where some of your data is quantitative where you have a standardized questionnaire and you can say, "We saw x percent change in anxiety..." and then some of it was qualitative where you basically present quotes from the interviews and you're putting forward people's own words to describe what they experienced.

People made a lot of comments about what a difference it made to them to have somebody come and work with them, and how much it helped them with different kinds of symptoms: pain, sleep, constipation. That stuff wasn't captured on the quantitative, formal scientific measure, but it came across in the interviews. That's actually going to be published in the article too.