title: Mindfulness-based stress reduction in an integrated care delivery system: one-year impacts on patient-centered outcomes and health care utilization.
abstract: BACKGROUND
  Mindfulness-based stress reduction (MBSR) programs have demonstrated clinical effectiveness for both mental and physical health conditions. Less research exists on health services utilization, self-efficacy, or work productivity outcomes.
  
  
  OBJECTIVE
  To assess one-year outcomes of MBSR in patients with chronic pain, chronic illness, or stress-related problems, measuring functional status, pain, self-efficacy, depression, anxiety, somatization, psychological distress, work productivity, and changes in health services utilization.
  
  
  METHODS
  A prospective single cohort design evaluated an eight-week MBSR program for Kaiser Permanente Colorado members. Patient-reported measures were collected at baseline, eight weeks, and one year following MBSR. Differences in health services utilization were compared from six months before MBSR to six months following the one-year anniversary of MBSR.
  
  
  RESULTS
  Most of the 38 participants were white (28; 74%), female (30; 79%), employed part-time (35; 92%), and average age 52.6 years, with multiple comorbidities (averaging 16.4 unique diagnoses), the most common being joint or back pain (28; 74%) and psychological disorder (20; 53%). Repeated measures analyses at 8 weeks (n = 26) and at 1 year (n = 24) showed significant improvements in self-reported mental and physical function, pain, psychological symptoms, and self-efficacy, but not work productivity. Significant decreases at 1 year were observed for visits in primary care (-50%, p < 0.0001), specialty care (-38%, p = 0.0004), and the Emergency Department (-50%, p = 0.04), and for hospital admissions (-80%, p = 0.02).
  
  
  CONCLUSIONS
  The MBSR program was associated with improvements in several patient-centered outcomes over 1 year and reductions in health services utilization up to 18 months.
authors: Medical Director for the Centers for Complementary Medicine at Kaiser Permanente in Denver, CO. tracy.mccubbin@kp.org.
authors: Tracy
authors: T
authors: Mccubbin
authors: Associate Professor in Psychology and Neuroscience at the University of Colorado Boulder. sona.dimidjian@colorado.edu.
authors: Sona
authors: S
authors: Dimidjian
authors: Medical Director of Clinical Prevention Services for Kaiser Permanente in Denver, CO. karinkempe@comcast.net.
authors: Karin
authors: K
authors: Kempe
authors: Business Services Manager for the Centers for Complementary Medicine for Kaiser Permanente Colorado in Aurora. melissa.s.glassey@kp.org.
authors: Melissa S
authors: MS
authors: Glassey
authors: Research Analyst at the Kaiser Permanente Institute for Health Research in Denver, CO. colleen.ross@kp.org.
authors: Colleen
authors: C
authors: Ross
authors: Director for Quality Improvement and Strategic Research at the Kaiser Permanente Institute for Health Research in Denver, CO. arne.beck@kp.org.
authors: Arne
authors: A
authors: Beck
mesh_terms: D019033:Delivery of Health Care, Integrated; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D064866:Mindfulness; D018802:Patient-Centered Care; D011446:Prospective Studies; D013315:Stress, Psychological / Q000628:therapy*; D011795:Surveys and Questionnaires