Eaves Emery R, Hsu Clarissa W, DeBar Lynn L, Livingston Catherine J, Ocker Laura E, McDonald Sarah J, Dillon-Sumner Laurel, Ritenbaugh Cheryl
1 Department of Anthropology, Northern Arizona University, Flagstaff, AZ.
2 Kaiser Permanente Washington Health Research Institute, Seattle, WA.
J Altern Complement Med. 2019 Mar;25(S1):S61-S68. doi: 10.1089/acm.2018.0431.
The authors employ a Whole Systems framework to explore implementation of new guidelines for back and neck pain in Oregon's Medicaid system. Whole Systems research is useful for understanding the relationship between complementary and integrative health care (CIH) and conventional health care systems in real-world clinical and practice settings.
Preliminary results are from an observational study designed to evaluate state-wide implementation of CIH and other non-pharmacological treatments for neck and back pain among Oregon Medicaid patients. This natural experiment, even in early stages, provides insight into the challenges of integrating Whole Systems oriented therapies into Medicaid billing and treatment.
Qualitative data are drawn from: (1) semi-structured interviews with representatives of each of the 16 coordinated care organizations (CCOs) responsible for administering the Oregon's Medicaid insurance through the Oregon Health Plan (OHP); and (2) open-ended survey responses from acupuncturists in all 16 CCO areas.
Implementation of the new policy guidelines poses logistical and epistemological challenges. Differences in worldview, inadequate reimbursement, and simple lack of awareness of CIH among medical providers are some of the factors that pose barriers to merging CIH therapies into conventional frameworks.
In this article, we explore the potential for a Whole Systems perspective to better explain the complexity of integrating CIH and other non-pharmacological services into a state financed health care system. Oregon's expansion of services for back and neck pain presents an opportunity to explore challenges and successes in melding multiple approaches to health and pain management into a managed system such as the OHP.
作者采用全系统框架来探索俄勒冈医疗补助系统中背部和颈部疼痛新指南的实施情况。全系统研究有助于理解在现实临床和实践环境中补充与整合性医疗保健（CIH）与传统医疗保健系统之间的关系。
初步结果来自一项观察性研究，该研究旨在评估俄勒冈医疗补助患者中CIH及其他非药物治疗方法在全州范围内对颈部和背部疼痛的实施情况。即使在早期阶段，这项自然实验也能让我们深入了解将全系统导向疗法纳入医疗补助计费和治疗的挑战。
定性数据取自：（1）对16个负责通过俄勒冈健康计划（OHP）管理俄勒冈医疗补助保险的协调护理组织（CCO）的代表进行的半结构化访谈；（2）来自所有16个CCO地区针灸师的开放式调查回复。
新政策指南的实施带来了后勤和认识论方面的挑战。世界观的差异、报销不足以及医疗服务提供者对CIH缺乏了解等因素，是将CIH疗法融入传统框架的一些障碍。
在本文中，我们探讨了从全系统角度更好地解释将CIH和其他非药物服务整合到由州资助的医疗保健系统中的复杂性的潜力。俄勒冈州对背部和颈部疼痛服务的扩展，为探索将多种健康和疼痛管理方法融入OHP这样的管理系统中的挑战与成功提供了契机。
