title: Referrals to integrative medicine in a tertiary hospital: findings from electronic health record data and qualitative interviews.
abstract: To examine patterns of, and decision-making processes, informing referrals for inpatient access to integrative medicine (IM) services at a large, acute care hospital.
  
  
  
  Retrospective electronic health record review and structured qualitative interviews.
  
  
  
  A 630-bed tertiary care hospital with an IM service available to inpatients.
  
  
  
  IM referrals of all inpatients aged ≥18 years between July 2012 and December 2014 were identified using the hospital's electronic health record. Fifteen physicians, 15 nurses and 7 administrators were interviewed to better understand roles and perspectives in referring patients for IM services.
  
  
  
  In the study hospital, primary sources of referrals for IM services were the orthopaedic and neuroscience/spine service lines. While the largest absolute number of IM referrals was made for patients with lengths of stay of 3 days or fewer, a disproportionate number of total IM referrals was made for patients with long lengths of stay (≥10 days), compared with a smaller percentage of patients in the hospital with lengths of stay ≥10 days. Physicians and nurses were more likely to refer patients who displayed strong symptoms (eg, pain and anxiety) and/or did not respond to conventional therapies. IM referrals were predominantly nurse-initiated. A built-in delay in the time from referral initiation to service delivery discouraged referrals of some patients.
  
  
  
  Conventional providers refer patients for IM services when these services are available in a tertiary hospital. Referral patterns are influenced by patient characteristics, operational features and provider perspectives. Nurses play a key role in the referral process. Overcoming cultural and knowledge differences between conventional and IM providers is likely to be a continuing challenge to providing IM in inpatient settings.
authors.affiliation: Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, Minnesota, USA.
authors.forename: Kristen H
authors.initials: KH
authors.lastname: Griffin
authors.affiliation: Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.
authors.forename: Kent C
authors.identifier: 0000-0002-1445-026X
authors.initials: KC
authors.lastname: Nate
authors.affiliation: Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, Minnesota, USA.
authors.forename: Rachael L
authors.initials: RL
authors.lastname: Rivard
authors.affiliation: Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.
authors.forename: Jon B
authors.initials: JB
authors.lastname: Christianson
authors.affiliation: Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, Minnesota, USA.
authors.forename: Jeffery A
authors.initials: JA
authors.lastname: Dusek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000592:standards; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration* / Q000592:standards; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research; D006801:Humans; D007297:Inpatients; D055048:Integrative Medicine / Q000458:organization & administration / Q000592:standards; D007407:Interviews as Topic; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D036301:Qualitative Research; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D062606:Tertiary Care Centers
keywords: COMPLEMENTARY MEDICINE; HEALTH SERVICES ADMINISTRATION & MANAGEMENT; QUALITATIVE RESEARCH