Building an Integrative Care Community

For the past 35 years, Oregon College of Oriental Medicine (OCOM) has made an impact globally through its graduates (over 1,300 in the MAcOM program and over 120 in the DAOM program) and locally through its clinics. OCOM operates teaching clinics in the Old Town Chinatown and Hollywood neighborhoods in the Portland area. They served over 3,500 patients in 2017, 62 percent from low-income households. Since 2014 OCOM has received grants from Kaiser Permanente Community Benefit Programs supporting access to acupuncture for low-income Portland-area patients.

These programs, along with the college's low-cost sliding scale fees, allow people to seek services including alternatives to opiates for chronic pain management. Analysis of patient survey data from 2017 shows that 96 percent of low-income patients with chronic conditions reported improvement after five treatments. Ninety-nine percent of patients were "extremely" or "very" satisfied. Thirty-seven percent reported that they did not use the emergency room due to access to health care at OCOM, which was funded by the grant. One recipient suffering from lower back pain, numb arms, asthma, and a mood disorder reported, "All four health problems are significantly improved. I believe I am avoiding possible neck surgery [as a result of treatment]. [With surgery] not only would I lose work time, I wouldn't be able to come to acupuncture as often as I do."

Beyond external funding, OCOM's clinical programs rely on partnerships with other safety net clinics. OCOM's Community Health Externship clinical sites include Project Quest, Central City Concern's Hooper Center and Old Town Clinic, which provides treatments in a group setting for health conditions including hepatitis, substance abuse, chronic mental illness and HIV/AIDS.

In 2018, OCOM developed two new hospital-based clinical partnerships to offer Master's program students with opportunities to work clinical rotations in integrative health care settings. The Legacy Health Pain Management Center, part of Legacy Health, is a multidisciplinary specialty practice with expertise in chronic pain management. In collaboration with Legacy providers, OCOM interns provide multiple approaches to manage the complex needs of pain patients. At the Providence Infusion Center, OCOM interns serve on multidisciplinary teams to provide outpatient care in a bio-medical setting to cancer patients receiving chemo and radiographic therapy.

Collaborating on Education

The college's commitment to integrative practice collaboration is enhanced by OCOM's location in Portland, Oregon, home to multiple graduate health science programs. As a founding member of the Oregon Collaborative for Integrative Medicine (OCIM), OCOM partners with Oregon Health Sciences University (OHSU), University of Western States (UWS), National University of Natural Medicine (NUNM) and Pacific University to host grand rounds, research conferences, poster sessions and strategic planning. The campus student chapters of OCIM institutions form the Student Alliance for Integrative Medicine (SAIM) which hosts annual events on integrative practice and communication among healthcare professional students. Another key collaboration among OCIM institutions is the Portland Area Health Libraries Consortium (PAHL) which offers members reciprocal borrowing of research resources from partner institutions. Perhaps the most impactful OCIM collaborative project is offering clinical sites for the Academy of Integrative Health and Medicine's (AIHM) first interprofessional integrative health and medicine fellowship. The two-year program is a hybrid model combining 1,000 hours in the virtual classroom with clinical rotations and three in-person retreats.

The Science of Medicine

Beginning in 2005, OCOM received a NIH/NCCAM grant as part of an initiative to infuse an evidence-based health care (EBH) perspective into academic and clinical training. The Acupuncture Practitioner Research Education Enhancement (APREE) grant was a collaboration with the Oregon Health and Science University School of Nursing. The grant program's initial goals were to strengthen research literacy, foster a culture of research appreciation and recognize the role of clinical experience and other forms of evidence in AOM education and clinical practice. The APREE research education initiatives were expanded after the initial grant ended, extending them to 2013.

Notable projects include the patient centered outcomes research (PCOR) program which OCOM has maintained since 2007 for all patients who receive intern-provided acupuncture. OCOM uses the PCOR data repository to track patient outcomes and conduct observational research, and it is available for master's and doctoral students interested in researching patient outcomes for specific conditions, demographics and AOM treatments. OCOM also developed two online resources to support evidence-based practice - AcuTrials and qiPARTNER. AcuTrials is a searchable online database of randomized clinical trials and systematic reviews using a comprehensive keyword thesaurus that categorizes trial details more extensively than other databases. AcuTrials contains over 1,500 indexed citations and is continuously updated. qiPARTNER is a practice-based research network and online repository for case reports. It is a novel resource of pragmatic clinical data with a focus on unusual cases and adverse events.

OCOM's latest research initiative, a statewide survey, is funded by a $10,000 grant from the Knight Cancer Institute Community Partnership Program at Oregon Health and Science University. The survey will assess the unmet needs of breast cancer survivors in Oregon and gauge interest in a future acupuncture and Chinese medicine-based survivorship program. According to OHSU Oncologist Jingjing Hu, MD, "the remarkable advances in cancer treatment have greatly improved the survivorship rates of breast cancer patients. Though positive, this also results in a large population of patients in need of ongoing, multi-modality support to manage cancer-related symptoms and improve the quality of life. I believe acupuncture and Chinese medicine will have an increasingly important role to play in this integrative approach in coming years, and this project is an important first step in determining the shape of that role for breast cancer patients in Oregon."

Research at OCOM has also increased access to acupuncture for Oregon's Medicaid recipients. Collaborative efforts between the OCOM Research Department and the Oregon Association of Acupuncture and Oriental Medicine (OAAOM) resulted in steady expansion of coverage for acupuncture under the Oregon Health Plan (OHP), which provides health care coverage to low-income Oregonians. In 2009 the OCOM Research Department and the OAAOM began locating, assessing and submitting high-quality research demonstrating acupuncture's effectiveness for numerous conditions to the Oregon Health Evidence Review Commission (HERC). Since 2009 acupuncture has been paired with eight conditions on the OHP prioritized list: pregnancy-related hyperemesis gravidarum, breech presentation, back and pelvic pain of pregnancy, post-stroke depression, disorders of the spine with neurologic impairment, chronic low back pain, migraine headaches and tension-type headaches. Chronic neck pain and osteoarthritis of the knee were also approved by the HERC in 2013. This ongoing collaboration demonstrates the valuable role of research at the public policy level in validating acupuncture's clinical effectiveness, expanding access to low-income citizens and supporting the expansion of the acupuncture profession.