Association of the Functional Medicine Model of Care With Patient-Reported Health-Related Quality-of-Life Outcomes | Complementary and Alternative Medicine | JAMA Network Open | JAMA Network
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    Original Investigation
    Complementary and Alternative Medicine
    October 25, 2019

    Association of the Functional Medicine Model of Care With Patient-Reported Health-Related Quality-of-Life Outcomes

    Author Affiliations
    • 1Center for Functional Medicine, Cleveland Clinic, Cleveland, Ohio
    • 2Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
    • 3Institute for Functional Medicine, Federal Way, Washington
    • 4Community Care, Cleveland Clinic, Cleveland, Ohio
    JAMA Netw Open. 2019;2(10):e1914017. doi:10.1001/jamanetworkopen.2019.14017
    Key Points español 中文 (chinese)

    Question  Is the functional medicine model of care associated with patient-reported health-related quality of life?

    Findings  In this cohort study of 7252 eligible patients (functional medicine center: 1595; family health center: 5657), functional medicine patients exhibited significantly larger improvements in Patient-Reported Outcome Measurement Information System Global Physical Health at 6 months than propensity-matched patients at a family health center (398 matched pairs). Improvements in Patient-Reported Outcome Measurement Information System Global Physical Health appeared to be sustained at 12 months but not significantly different from those at the family health center.

    Meaning  The findings of this study suggest that functional medicine may have the ability to improve global health in patients.


    Importance  The incidence of chronic disease is increasing along with health care–related costs. The functional medicine model of care provides a unique operating system to reverse illness, promote health, and optimize function. The association between this model of care and patient’s health-related quality of life (HRQoL) is unknown.

    Objective  To assess the association between functional medicine and patient-reported HRQoL using Patient-Reported Outcome Measurement Information System (PROMIS) global health measures.

    Design, Setting, and Participants  A retrospective cohort study was performed to compare 7252 patients aged 18 years or older treated in a functional medicine setting with propensity score (PS)–matched patients in a primary care setting. Sensitivity analyses assessed improvement limited to patients seen at both 6 and 12 months. The study included patients who visited the Cleveland Clinic Center for Functional Medicine or a Cleveland Clinic family health center between April 1, 2015, and March 1, 2017.

    Main Outcomes and Measures  The primary outcome was change in PROMIS Global Physical Health (GPH) at 6 months. Secondary outcomes included PROMIS Global Mental Health (GMH) at 6 months and PROMIS GPH and GMH at 12 months. The PROMIS GPH and GMH scores were transformed to a T-score from 0 to 100 with a mean of 50. Higher scores indicate a better health-related quality of life.

    Results  Of the 7252 patients (functional medicine center: 1595; family health center: 5657), 4780 (65.9%) were women; mean (SD) age was 54.1 (16.0) years. At 6 months, functional medicine patients exhibited significantly larger improvements in PROMIS GPH T-score points than were seen in patients treated at a family health center (mean [SD] change, functional medicine center: 1.59 [6.29] vs family health center: 0.33 [6.09], P = .004 in 398 PS-matched pairs). At 12 months, functional medicine patients showed improvement similar to that observed at 6 months; however, comparisons with patients seen at the family health center were not significant. Patients in the functional medicine center with data at both 6 and 12 months demonstrated improvements in PROMIS GPH (mean [SD], 2.61 [6.53]) that were significantly larger compared with patients seen at a family health center (mean [SD], 0.25 [6.54]) (P = .02 in 91 PS-matched pairs).

    Conclusions and Relevance  In this study, the functional medicine model of care demonstrated beneficial and sustainable associations with patient-reported HRQoL. Prospective studies are warranted to confirm these findings.