A view from the desk of a medical director: Integrative centers and accountable care organizations as approaches to OA

Osteoarthritis (OA) presents a clinical dilemma, in part, because our high tech imaging studies and biomarkers of pathology do not correlate well with actual suffering and disability. As a result, purely technological clinical solutions are often disappointing in the long term. Much energy is expended debating “appropriateness criteria” for the latest procedures rather than assessing the nature of the suffering and the actual goal and best type of care needed by each individual patient.

A multidisciplinary integrative healthcare team may be best suited to managing patients with OA. An effective team is comprised of selected “complementary and alternative” providers working side by side with conventionally trained medical doctors. Practitioners have no single shared healing paradigm or philosophy, but may have roots in Western, Asian, naturopathic, manual, functional, nutritional and behavioral medical traditions. All clinicians practice experienced-based and evidence-informed health care with an attitude of mind that preferentially seeks those therapies or therapeutic lifestyle changes that enhance one's innate ability to recover from illness and maintain good health. For OA there is a focus on the patient's physical and emotional experience of illness, education, self-management, prevention and manual and non-pharmacological therapies that strengthen the endogenous joint and supporting structures. This presentation explores the substantial challenges associated with recruiting, credentialing and developing a cooperative team that is capable of effectively caring for patients with OA and communicating via a shared hospital-wide electronic medical record and participating in ongoing education and research.