Assessing quality in complementary and alternative medicine

Background: Although the field of quality assessment in CAM is relatively new, investigators have studied a variety of structure, process, and outcome-related topics. Using a conceptual framework developed by Donabedian in health services research, the presentation will describe results of a literature search on evaluating quality of CAM care. Structural characteristics affecting quality include institutional aspects and characteristics of an organization; process indicators refer to specific aspects of providing care; outcome measures include changes in health status, adverse events, and liability. Methods: Using keywords such as “quality assessment in CAM” and “quality measures in integrative care”, a search was conducted using the National Library of Health and PubMed. Articles in English that were published from the mid-1980's to the present were prioritized. Following the system developed by NIH's National Center for Complementary and Alternative Medicine (NCCAM), the search included articles on the 5 domains of alternative medical systems, mind-body interventions, biologically-based therapies, manipulation and body-based methods, and energetic treatments. Results: Over 200 articles were identified. The majority of these (n = 170) dealt with outcome measures, such as adverse events, patient and provider satisfaction, and economic response. Forty-two articles dealt with structural issues, particularly provider training, licensing, and credentialing. Process indicators were addressed in 31 articles, including treatment planning and team approach, developing practice guidelines, and determining scope of CAM practices. Recommendations: Because the purpose of evaluating quality is to improve it, CAM providers and researchers owe it to our stake-holders to take quality assessment seriously.