PAST RESEARCH GRANTS

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Our Vision

• To serve as a catalyst for change in healthcare
  delivery and medical education
• Success Integrative Medicine no longer exists

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Duke Integrative Medicine

• The Challenge
• To develop, demonstrate and implement effective
  innovative models of care, and appropriately
  integrate them into the larger healthcare system

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The Process

• Learning from our patients
• The retreat model
• The health planning and coaching proof of concept
• Applying the concepts across the system
• The opportunity to create a living laboratory for
  working models

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Intervention in Patients at Risk for Heart Attack
or Stroke

• Test of this concept and process
• Initial visit with integrative physician
• Ten months with Health Coaching Group
• Education in domains of the health wheel
• Mindfulness Meditation
• Focuses on being aware of experiences and
  thoughts in the moment
• Can help people become aware of conscious and
  unconscious choices

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Intervention

• Teaching new skills
• Muscle relaxation
• Stress Management
• Self-exploration activities
• Coaching focuses on
• support in personal reflection
• setting specific goals
• rewarding progress
• overcoming barriers

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Readiness to Change

• Percentage of patients preparing to or actively
  engaging in each health behavior

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Outcomes Health Behaviors
plt0.001 for eating, p0.002 for exercise, pgt0.1
for smoking
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Outcomes CV Risk Factors
pgt 0.01 for all
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10 Year Risk of CHD (N154) P0.006 at 5 mo,
P0.04 at 10 months
0.12
0.1
0.08
CHD Risk
0.06
0.04
0.02
0
0
5
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Time in Months
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Key Findings

• Significantly reduced the risk of heart attack or
  stroke in the next ten years
• Peoples lives changed dramatically, health
  changes were a by-product

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Applying the Model Across the System
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Duke Prospective Health for Employees

• 9 sessions of group coaching over 3 months
• Monthly education sessions
• Quarterly skill building
• Weekly e-health tips

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Duke Prospective Health for Employees Results

• Decreased in-patient admissions by 25.4
• care management by 20.0
• Limited program (2 coaching sessions and monthly
  education) decreased by 14.3
• care management 18

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The Opportunity to Create a Living Laboratory
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A Dedicated Environment

• Provide the ideal, state-of-the art healing
  center
• The patient experience
• The educational opportunity
• Translate across the health system

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The Perfect Storm

• A culture of innovation
• A chancellor with vision and courage
• An amazing philanthropist
• A 26 acre wooded campus
• Support across the faculty

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A Dedicated Environment

• 27,000 Square Foot Center
• 14 therapeutic consult and treatment rooms
• 2 meditation spaces
• Small medical laboratory
• 4 multipurpose rooms
• 2 transition rooms and quiet room
• Library
• Demonstration kitchen and cafe
• Small fitness center
• Contemplative courtyards and gardens
• Labyrinth

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A Dedicated Environment

• Sacred geometry
• The interface with nature
• The four seasons
• Attention to every detail
• A healing environment
• Green features
• A learning environment
• An experiential environment
• A place where a visit to your doctor can be
  rejuvenating and health promoting

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What We Have Learned
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Key Distinctions

• Planning for health
• The healthy executive
• A focus on healing
• After cancer, or a heart attack
• Whole person strategies
• The person living with a chronic condition

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Key Distinctions

• Support in behavior changes
• Immersion experiences
• Health Coaches
• The power of community
• Coordination of health care across time
• Our enrollment practice your personal physician
  advocate

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Clinical Strategy Dedicated Environment, Ideal
Models of Care

• The Platinum Membership
• Begins with a Health Immersion experience
• Creation of your Personalized Health Plan
• Partnership, coaching and advocacy throughout the
  year

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Raising the Bar Optimal Health and Vitality

• Duke has provided a unique health experience,
  offering a true sense of professional,
  individualized care with each provider addressing
  my whole being mind, body, and soul. I have
  made lifestyle changes in the areas of physical
  fitness, nutrition, and spirituality that have
  lifted me to a renewed state of life I didnt
  know was possible.
• Powerful and empowering taking control of your
  health for a better, more energetic, more
  harmonious approach to life and relationships.
• I have been led by medical professionals to a
  new beginning. As a result, I now have a plan to
  live a healthy, well-balanced and much improved
  Integrative lifestyle.

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Translation across the system and community

• A Model Practice
• Translation across the health system
• Ambulatory Services
• Inpatient care
• Employees
• Translation into the community
• The Role of Integrative Health Coaching

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Integrative Health Coaching Professional Training

• 4 modules of training, 4-5 days each
• 8-12 months to complete
• Living it as you learn and teach it
• 40 people maximum

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Integrative Health Coaching Training Modules

• 1 Coaching and mentoring throughout the Wheel
  of Health
• Our coaches coach you
• 2 and 3 Behavior Change
• Coaching each other
• 4 Applying this to your community
• 11, groups, corporate, building resources

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Integrative Medicine Education

• Duke Faculty Development
• Duke Graduate Medical Education
• Duke Medical Students
• Other Health Professions - Nursing, PA, PT,
  Premed
• Integrative Health Coaching Professional Training

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Research Mission

• To evaluate the efficacy and cost of integrative,
  personalized models of care

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Research

• Continue to research models of care
• Build research infrastructure to support mission
• Practice Based Research Network (PBRN) in
  Integrative Medicine
• 1M over 3 years
• Duke is the National Coordinating Center
• Mindfulness and dis-ordered eating

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Translation of Innovative Models The Next
Perfect Storm
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A Partnership between Duke IM and the Cliffs

• Shared vision
• Synergy of our strengths
• The opportunity for revolutionizing health care
  in America

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Duke Integrative Medicine Joins Forces with The
Cliffs

• Together, we have developed a 12-month program
  designed to help you
• Maintain and enhance your state of wellness
• Immerse yourself in the highest level of
  integrative care
• Maximize your health for years to come

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Core Program Elements

• Medical therapeutic sessions
• Integrative case conference health plan
• Integrative health coaching
• Classes, workshops, and relaxation

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Medical Therapeutic Sessions

• Pre-assessment discussions to determine the right
  combination of services and sessions to
  address your personal needs and goals
• 90-minute integrative medicine physician
  consultation and examination (as needed), which
  will provide the foundation of your care
• Your choice of five therapeutic sessions or
  consultations, including
• Nutrition
• Massage
• Acupuncture
• Mind body wellness
• Fitness
• Physical therapy
• For golfers, a special therapeutic session with
  our physical therapist to analyze your form and
  any imbalances

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Integrative Case Conference Health Plan

• Your physicians, providers, and health coach will
  meet to share their observations and create
  recommendations for optimizing your health
• Ensures a comprehensive and truly integrative
  approach
• Two physician check-ins during your Health
  Immersion experience and two follow-up check-ins
• Helps to keep you on the path to enhanced
  wellness
• Wrap-up session with your physician
• To review your personalized health plan and the
  recommendations and insights discussed in your
  case conference

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Classes, Workshops, and Relaxation

• A balanced schedule of classes and workshops
  providing a foundation in mindfulness and
  self-care strategies and skills
• Delightful and nutritious meals and snacks from
  our cafe throughout your stay.
• Time to immerse yourself in our unique facility
• Hot tub
• Steam room
• Sauna
• Fitness room
• Meditative spaces
• Tranquil surroundings
• An eight-part lecture series and time for
  informal check-ins, with questions and answers
  given by Duke faculty at The Cliffs over the next
  year to enrich and inform your personal journey
  toward optimal health and wellness

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Integrative Health Coaching

• Initial session designed to help you explore and
  clarify your goals
• Personalized health plan developed by you and
  your physician, health coach, and therapeutic
  team based on collaborative and integrative
  assessments
• Regular check-ins with your health coach during
  your stay
• Integrative health coaching sessions, including
  individual and group calls, for six months
  following your visit to help you overcome
  obstacles to achieving your health goals

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Tacking Outcomes
40 to 50 Participants Collecting outcomes at
baseline, 6 month, and 12months
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IOM Rules for the 21st Century Health Care
System Crossing the Quality Chasm, Institute of
Medicine, 2001

• Current Approach
• Care based on visits
• Professional autonomy drives variability
• Professionals control care

• New Rule
• Care based on continuous healing relationships
• Care is customized according to patient needs and
  values
• Patient is source of control

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The Opportunity The Second Revolution in
Healthcare
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The First Revolution in Healthcare

• Bringing science into medicine
• The Flexner Report in 1910, together with a
  demonstration project
• Johns Hopkins School of Medicine

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The Second Revolution in Healthcare

• Bringing Life and Health into Medicine
• The time is now for Flexner II in 2010, with a
  demonstration project
• Partnering academic medicine with living
  communities to create a true healthy living care
  model
• The first step in creating a Healthy America

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The greatest barrier to discovery is not
ignorance but the illusion of knowledge.

• David Borstein