Osteopathic Recognition What does THAT look like?

3/9/2015
Osteopathic Recognition
What does THAT look like?
Kari Hortos, DO
Chief Academic Officer
Statewide Campus System-MSUCOM
Associate Dean-MSUCOM-Macomb University Center
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To determine the efficacy of OMT in the treatment
of pneumonia in the elderly.
*MOPSE is a registered (http://www.clinicaltrials.gov, NCT00258661), double-blinded, randomized,
controlled trial conducted from March 2004 to April 2007 with a 60-day post-admission follow-up period.
Hospital Sites:
*MOPSE is a registered (http://www.clinicaltrials.gov, NCT00258661), double-blinded, randomized,
controlled trial conducted from March 2004 to April 2007 with a 60-day post-admission follow-up period.
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OMT
Group
(n=135)
Subject
(n=406)
Light Touch
Group (LT)
(n=136)
OMT: Twice a day
7 days a week
15 minutes duration
Primary Outcomes:
1) Length of Hospital
Stay
2) Time to Clinical
Stability
3) Rate of Symptomatic
and Functional
Recovery
Secondary Outcomes:
•
Duration of IV
Antibiotic Use
•
Duration of elevated
white blood count
•
Hospital
Complications
•
Mortality
•
Pt Satisfaction
•
60-day Re-admission
LT: Twice-a-day
7 days a week
15 minutes duration
Usual Care
Only Group
(n=135)
*MOPSE is a registered (http://www.clinicaltrials.gov, NCT00258661), double-blinded, randomized,
controlled trial conducted from March 2004 to April 2007 with a 60-day post-admission follow-up period.
84 Treatment Providers
20 Osteopathic NMS/OMT Specialists
64 Residents
12 residencies
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Emergency Medicine
Family Medicine
Family Medicine/ONM
General Surgery
Internal Medicine
Internal Med/Emergency Med
Interns
Obstetrics and Gynecology
Orthopedic Surgery
ONM
PM&R
Psychiatry
*MOPSE is a registered (http://www.clinicaltrials.gov, NCT00258661), double-blinded, randomized,
controlled trial conducted from March 2004 to April 2007 with a 60-day post-admission follow-up period.
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Washington D.C, October 26, 2008
Adjunctive Manual Treatment
for Older Adults Hospitalized with
Community-Acquired Pneumonia
Length of Hospitalization: 50-74y/o
50-74 years of age
PP Analysis
RESULTS:
LOH was reduced by 1 day
in the OMT Per Protocol
Group.
• OMT = 2.9 days
• LT = 3.5 days
• CC = 3.9 days
ITT Analysis
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Adverse Events
75+ years of age
RESULTS:
In the over 75 y/o ITT group
the mortality was decreased
for both OMT and LT.
Final Study Results*
The OMT group
Per Protocol Analysis:
• Reduced LOS
• Reduced duration IV Ab
• Reduced respiratory failure
and death
The Intention to Treat Group
• No difference between groups
*Noll et al. Efficacy of osteopathic manipulation as an adjunctive treatment for
hospitalized patients with pneumonia: a randomized controlled trial. OMPC 2010,4:2
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WWW.COM.MSU.EDU/CME
www.scs.msu.edu
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Requirement I.C.1
Four tenets of osteopathic medicine:
a) The body is a unit; the person is a unit of body, mind, and
spirit.
b) The body is capable of self-regulation, self-healing, and
health maintenance.
c) Structure and function are reciprocally interrelated.
d) Rational treatment is based upon an understanding of the
basic principles of body unity, self-regulation, and the
interrelationship of structure and function.
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“To find health
should be the object
of the doctor.
Anyone can find
disease.”
-Andrew Taylor Still 1899
Impact of Physician BMI on Obesity Care
and Beliefs
-Bleich et al; Obesity: Jan 2012
Survey 1° care physicians N=500
• BMI Range:
– Normal (47%)
– Overweight/obese (53%)
• Probability of recording an
obesity dx
– 93% vs 7%
• Initiate weight loss conversation:
– 89% vs 11%
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Changing Behavior
Transtheoretical Stages of Change
Prochaska’s Stages of Change*
STAGE
ATTITUDE
%
Pre-contemplation
Never
50-60%
Contemplation
Someday
20-40%
Preparation
Soon
10-15%
Action
Now
5-10%
Maintenance
Forever
*Am Psych 1992;47(9):1102-14
Expert vs Coach
Skill Sets
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Physician Expert
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Authority
Educator
Defines agenda
Responsible for patient health
Solves problems
Disease focus
Has answers
Working harder than patient
Physician Coach
•
•
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•
Partner
Facilitator of change
Elicits patient’s agenda
Patient responsible for health
Foster possibilities
Health focus
Patient works as hard as coach
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*American College Preventive Medicine; JAMA 2010
Academy Lifestyle Medicine
Multidisciplinary Advisory Board responsible for:
• Curriculum review
• Selection of pre-clerkship fellowship candidates
• Program development
Advisory Board Members:
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Kari Hortos, DO Lead
Lori Dillard, DO
Terri Hammer, DO
Adam Feinstein, DO
Laurie Kaufman, MD
Sarah McCaskey, MA, RD
Ryan Vinson MPT, OMPT
Dayna Elfont, DO
Robin Bingham, MA
Saroj Misra, DO
Internal Medicine/Fellowship trained nutrition
OMM Faculty
OMM Faculty
OMM Faculty
Endocrinologist/fellowship trained nutrition
Registered dietitian and MSUCOM faculty
Physical Therapist and Oakland Univ. clinical faculty
Family Medicine/ACSM certified health and wellness coach
Director WW of Michigan
Family Medicine/Clerkship director and FM residency faculty
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Health Promotion Practicum
Purpose:
2013
To improve the medical student’s
confidence in:
– Addressing their own health habits
with motivational and behavioral
skills learned each week as
measured by diet and exercise
patterns.
– Addressing patients’ diet and
exercise patterns through the
application of skills learned from this
practicum.
2014
2015
Approved by MSU Institutional Review Board; Dec. 2012 #i-042364
MSUCOM Lifestyle Medicine
Pre-clerkship Fellowship
Purpose:
• To develop physician
competencies for prescribing
Lifestyle Medicine.
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Leadership
Knowledge
Assessment skills
Management skills
Use of Office and community support
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