Potentially avoidable hospitalizations are common and costly in the dually eligible population. New initiatives are needed to reduce PAH in this population as they are costly and can adversely affect function and quality of life.

Lower cognitive function may be a barrier to outpatient care, but these analyses should be repeated using administrative use and cost data.

From a holistic perspective, CAM treatment effects can arise in part from sources related to the therapeutic relationship, as well as the philosophy of healing and specific techniques designed to reduce symptoms. This analysis provides conceptual support for this perspective, a means to evaluate aspects of the therapeutic relationship and to measure its impact on outcomes of CAM treatment across conditions and therapies.

Abstract:The purpose of this study was to examine the benefits associated with complementary and alternative medicine (CAM) treatments from the patients' perspective using a whole systems research approach as a guiding framework. We conducted five focus groups of six to eight participants each, with users of CAM recruited through experienced CAM providers and clinics. Eligible participants were aged 21 or older, had used CAM in the last 12 months, and believed the treatment to be beneficial. The focus group discussions were digitally recorded, transcribed, and analyzed through a qualitative content analysis. Responses were inductively coded for common themes, and then placed into broader conceptual categories reflecting the CAM outcome domains suggested by Verhoef and colleagues. Participants described physical health benefits including symptom relief and improved function, and positive psychological benefits such as improved coping and resilience. Social health benefits that arose from the positive aspects of the patient-practitioner relationship were also reported, including support and advocacy. In addition, participants identified empowerment, increased hope and spiritual growth as results of receiving CAM treatments. A new behavioral health outcome domain emerged as participants reported that CAM use had fostered behavioral changes such as increased exercise, smoking cessation and improving their diets. These patient-reported benefits of CAM treatment are consistent with the outcome model proposed by Verhoef and colleagues, and extend this model by identifying a new outcome domain-behavioral health outcome. The findings provide insight and direction for the development of outcome and process measures to evaluate CAM treatment effects.

Relying on self-report in evaluating functional status may underestimate disability in clinical evaluations, level of care determinations and service planning. Researchers and policymakers should also take mode of administration effects into account when estimating or comparing disability rates.