Overview
Patients' treatment outcomes have been scrutinized using a validated and nationally-recognized quality of life metric that looks at physical and emotional functioning. The survey, developed by John Ware, PhD of the Dartmouth-Tufts Medical Outcomes Trust, is called the Dynamic Health Assesment Short Form 36 (DYNHA SF-36).

The Medical Symptom Questionnaire (MSQ) is used nationally by practitioners of Functional Medicine and is favored by a number of True North providers as part of patient history taking and following response to treatment. Projects which have been completed are listed under Past Projects at the bottom of this page.

A New Compass for Depression Screening & Treatment: True North’s Integrative Pilot
Program 2009
Approximately 4% of the population is clinically depressed. Depression is widely under-diagnosed. Interventions for depression are sub-optimally effective. Many patients presenting at True North, an Integrative Medicine Center, with somatic complaints are at risk for depression. Functional Medicine, Healing Arts, Complementary and Alternative (CAM) are novel and promising approaches that warrant well-designed investigation. Locus of control scores may correlate with response to treatment and provide a useful way to identify future responders and guide therapy.

Our objective with this study is to screen patients for depression using the Patient Health Questionnaire-9 (PHQ-9), establish the severity of depression, refer timely those at emergent and urgent risk, screen for reversible medical causes of depression, customize patient-centered interventions, and monitor the response to treatment. Changes in phq-9 scores will be analyzed by locus of control score quintiles. Identified areas of promise will guide further study.
Read more about this study (PDF)
(If you encounter errors while trying to follow the links in this PDF document, simply copy and paste the URLs into your web browser.)

DYNHA MSQ Correlation Study
True North conducted a study which shows fairly high correlation between the DYNHA and the MSQ. We want to be using valid tools to measure our performance for patient care. Read more about this study.

MSQ C-Reactive Protein (CRP) Correlation Study
True North providers have been interested in the emerging role of inflammation in chronic disease such as heart disease, dementia risk, cancer risk and even depression. We have studied whether the common inflammatory marker tested on blood called C Reactive Protein (CRP) is correlated with MSQ scores. The data from True North practice while not positively ruling out a relationship, shows that a significant correlation is not likely. Read more about this study.

DYNHA Patient Tracking: The First 4.5 Year Experience
Patient tracking using the DYNHA SF-36 showed some logistical difficulties, in spite of the low anticipated burden on patients and providers. Patients and clients who took multiple DYNHA surveys when seeing practitioners at True North had improved generic quality-of-life health functioning. Improvements in the mental health domain were greater than those in the physical functioning domain. Read more about this study.

True North Patient Satisfaction & Perceptions Study
The American College of Physicians patient satisfaction survey tool with 45 items as been implemented at numerous True North practices. The first stage of this study focused on metrics to inform quality improvement initiatives. A later version of the tool used was customized by adding several questions specific to lifestyle, exercise, nutrition and stress reduction and is actively measuring patient experiences throughout the clinical and complementary practices at the center. See True North Patient Satisfaction Survey

Preliminary findings based on 114 visits in 1.5 months show encouraging results:

• 81% of patients/clients say they are healthier since coming to True North
• 67% of patients/clients say they eat better since coming to True North
• 37% of patients/clients say they exercise more since coming to True North
• 43% of patients/clients say they are closer to their optimal weight since coming to True North

True North Provider Patient Interaction
Perceptions Study
Relationship and reverence are core values at True North. Using the patient satisfaction survey developed by the American College of Physicians, patient/client perceptions of their practitioners is being studied. For selected practitioners, the results will catalyze a customized practice improvement project with the aim of then measuring improvements in the practitioner-patient/client relationship.

This pilot was approved as part of an American Board of Internal Medicine practice improvement module toward maintenance of certification. See the survey.

The Efficacy of Complementary and Alternative Medicine Approaches for the Treatment of Depression in an Integrative Healthcare Setting 
This study attempted to take a ‘one-size-fits-some’ approach to examining the relative efficacy of two alternative approaches for treating self-reported depression. This small contribution to the evolving paradigm of personalized healthcare highlights the need for creative, credible research methodologies for evaluating individualized therapies in clinical settings. It is hoped that the results of this real-world study will have practical clinical applicability for the delivery of functional medicine and CAM therapies, and pave the way for future research on alternative therapies for the treatment of depression.  The study was conducted by the Hygeia Foundation d/b/a True North Research Circle with assistance from Misty Mallar, BA, University of New England.
Read the detailed study here.
See the full data set here.

First Line Therapy Research Project
Patients enrolled in the First Line Therapy™ program for therapeutic lifestyle change are evaluated in a variety of ways at the start and again at the completion of their 12-week program. Summary and descriptive statistics are being compiled on the following parameters and will be analyzed when a sample of 100 subjects has been gathered. We are particularly interested in looking at adults at risk for:

• Heart disease
• Stroke
• Diabetes
• Arthritis
• Osteoporosis
• Overweight/Obesity
• High cholesterol
• High blood pressure
• High blood sugar
• Alzheimer's disease

Read more about this research.

PAST PROJECTS

Omega 3 Essential Fatty Acids, Vitamin B12 and Folate Supplementation versus fluoxetine for Depression
This study aimed for 80 patients to complete to 3 months for significance, 192 to be enrolled to compensate for expected attrition.

Test Hypotheses:
1) Giving Omega-3 FA, folate and B12 supplementation will reduce phq9 scores for depression.
2) A change in inflammatory markers is associated with response to omega-3 or folate-B12, intrinsic factor supplementation.
3) A change in serum levels of B12 and folate correlates with improved phq-9 score.

For adults with mild or moderate major depression, does taking daily supplementation of a high quality EPA-rich omega-3 fatty acid taken in conjunction with a folate- B12- intrinsic factor supplement, when compared to fluoxetine 20 mg per day, safely improve depression scores (phq9) at 3 months? Further, does it improve emotional and physical functioning as measured by the DYNAmic SF-36 quality of life metric, reduce hospitalization days or missed work days or suicidal ideation? Further, does response correlate with either marker of inflammation, Interleukin-6 or hsCRP?

Note: This study did not go forward because of a new UK Bristol study showing no effect of Omega3s EPA:DHA 1.5 gms/day for mild-mod depression at 3 months. The Bristol study appears to answer (in the negative) the most important question of the True North-sponsored proposed Omega-B trial.

Read the True North study design and metaanalysis. The funnel plot on page 9 shows a summary of the data that convinced True North and associated investigators to terminate the OmegaB study.

Read the Bristol study results.

Hypnosis for Nocturnal Enuresis (Bedwetting Kids)(Pilot Study)
This qualitative study reviewed the charts of 70 children whose parents  brought them to see a pediatric hypnotherapist for bedwetting. Data from the charts included age, enuresis questionnaires, comorbidities, other treatments, duration, and number of visits. Of the 28 mothers that could be reached for phone interviews, 19 were interviewed. Many patients benefitted, though the study numbers were too few for statistical significance. Results were used as Quality Improvement feedback for the practitioner.

Portland Time Bank Study
Since 2002, Portland Time Bank (PTB) and True North, two nonprofit organizations, have offered an innovative approach to health care for uninsured or underinsured PTB members. Our collaboration allows income-eligible PTB members (225% of the Federal Poverty Level) to pay for health care at True North with units of service (valued equally regardless of skill level) that are “banked” by members and then exchanged as credits and debits. This pioneering relationship between PTB and True North has paved the way for other health care providers to pilot similar programs.

We looked at patients who use time dollars to pay for care at True North over a two year time period and analyzed their outcomes based on the MSQ and DYNA SF-36. Read the study results here.

Reilly Fund
Named for founding donor, David Reilly, FRCP, MRCGP, FFHom, Lead Consultant of the Homeopathic Hospital in Glasgow, Scotland, the Reilly Fund seeks to assist individuals who meet financial criteria gain access to care at True North. The Reilly Fund is intended to be a bridge for patients who need short-term assistance in dealing with a specific health problem or issue. Awards from the Reilly Fund come in the form of services and eligible items include laboratory tests, supplements, office visits and classes at the True North Institute.

We looked at patients who were given Reilly Fund grants to pay for care at True North over a two year time period and analyzed their outcomes based on the MSQ and DYNA SF-36.