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January 20, 2011 Volume VII, No. 28

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

Can social influences affect both weight status and loss? If so, which age group is most affected? Find out in this week's issue, along with the latest MRSA treatment guidelines. Our featured white paper describes how healthcare organizations react to MRSA outbreaks.

Your colleague in the business of healthcare,
Jessica Papay
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. Weight Status Influences
  2. Heart Attack, Survival Rates
  3. The Role of NPs
  4. Pediatric Obesity Program
  5. Health Incentive Eligibility
  6. Reacting to MRSA Outbreak
  7. MRSA Treatment Guidelines
  8. Healthcare Case Management in 2011

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Family, Friends, Social Ties Influence Weight Status in Young Adults

Does obesity tend to “cluster” among young adults? And if so, what impact does it have on both their weight and weight-related behaviors? Researchers from The Miriam Hospital’s Weight Control and Diabetes Research Center set out to better understand how social influences affect both weight status and weight loss intentions in this difficult-to-reach age group. According to the study, overweight and obese young adults between 18 and 25 were more likely to have overweight romantic partners and best friends and also had more overweight casual friends and family members compared to normal weight peers. Also, overweight and obese young adults who reported having social contacts trying to lose weight had greater weight loss intentions.

The study included 288 young adults between 18 and 25; 151 individuals were of normal weight, while 137 were considered overweight or obese (BMI of 25 or greater). The majority of participants were female and Caucasian. All participants completed questionnaires to determine their weight and height, number of overweight social contacts (including best friends, romantic partners, casual friends, relatives and colleagues/classmates) and perceived social norms for obesity and obesity-related behaviors. Overweight and obese study participants completed additional questionnaires to assess how many of their overweight social contacts were currently trying to lose weight, perceived social norms for weight loss (such as how frequently social contacts encouraged them to lose weight or whether the people closest to them would approve if they were to lose weight), and intentions to lose weight within the next three months.

Compared to normal weight young adults, those who were overweight or obese were more likely to have an overweight romantic partner (25 percent vs. 14 percent) and an overweight best friend (24 percent vs. 14 percent). “Our data suggests that obesity ‘clusters’ in this population. But interestingly, social norms for obesity did not differ between the two groups and did not account for the clustering,” said the researchers. “Both groups reported similarly low levels of social acceptability for being overweight, eating unhealthy foods and being inactive.” The study also showed overweight and obese young adults who had more social contacts trying to lose weight were more likely to want to lose weight themselves. Social norms for weight loss, such as encouragement and approval from social contacts, account for this association, researchers say.

Forty percent of young adults age 18-25 are considered overweight or obese, and young adults experience the highest rate of weight gain per year — typically one to two pounds — of any age group. While previous research has consistently demonstrated the powerful impact of social influence on health behaviors, especially for younger individuals, no previous study has examined whether social ties influence weight status and weight loss intentions among young adults. The researchers also point out that young adults are less likely to participate in behavioral weight loss interventions, and when they do, they tend to lose less weight than older adults. “Identifying the factors that influence both weight status and weight control in this high-risk age group can help us develop appealing and effective obesity treatment and prevention programs for this population,” said the researchers.

To learn more about this research, please visit:

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Some Heart Attack Rates Declining, Survival Improving

Coronary syndromes vary in severity, ranging from unstable angina, non-ST segment elevation myocardial infarction (NSTEMI), to ST-segment elevation myocardial infarction (STEMI), the most severe diagnosis. Little data exist about changing trends in acute myocardial infarction and whether death rates are increasing or decreasing. In a study published in the January 2011 issue of "The American Journal of Medicine," investigators found that STEMI rates decreased and one-year post-discharge death rates decreased in NSTEMI and STEMI patients.

Using data from the Worcester Heart Attack Study — an ongoing population-based investigation examining long-term trends in the incidence rates, in-hospital and post-discharge case fatality rates (CFRs) of greater Worcester, Massachusetts — researchers examined the medical records of 5,383 patients hospitalized for either STEMI or NSTEMI between 1997 and 2005 at 11 greater Worcester medical centers. Trained physicians and nurses abstracted demographic and clinical data, including patient’s age, sex and medical history (including previous MI events). Information about the use of important cardiac medications, coronary angiography, percutaneous coronary interventions (PCI) and coronary artery bypass graft surgery was also collected. Any records of various clinical complications during hospitalization were noted. Survival status after hospital discharge was determined through a review of medical records and search of death certificates. Some form of follow-up after hospital discharge was obtained for more than 99 percent of discharged patients.

The incidence rates per 100,000 population of STEMI decreased from 121 to 77 between 1997 and 2005. A significant increase in the NSTEMI incidence rates occurred in 2001, after which point NSTEMI incidence rates decreased. Overall, there was a slight increase in the incidence rates of NSTEMI between 1997 and 2005. There were notable differences in treatment utilization trends. A greater increase in the hospital use of beta-blockers was noted among patients with NSTEMI, whereas a greater increase in the use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers, cardiac catheterization and PCI was noted in patients with STEMI. Encouraging declines in one year death rates were observed for patients with STEMI or NSTEMI. The odds of dying during the first year after hospital discharge decreased steadily among patients with STEMI between 1997 and 2005. By 2005, the odds of dying within one year after discharge was 50 percent lower among STEMI patients in comparison with those admitted in 1997; a non-significant and inconsistent trend toward lower odds of dying within one year of hospitalization was noted among patients with NSTEMI.

The researchers stated, "Mortality from NSTEMI remained significantly higher than STEMI at both 30 days and one year. The higher long-term death rates observed in patients discharged after NSTEMI may have resulted from the fact that patients with NSTEMI were in general older and had a greater burden of cardiovascular comorbidities. Under-utilization of effective cardiac medications and PCI, as well as greater delays in the time to receipt of PCI in patients with NSTEMI, may also have contributed to differences in the post-discharge death rates observed in these patients. Increased attention needs to be directed to secondary prevention practices in the hospital and post-discharge management of patients hospitalized with NSTEMI because the proportion of NSTEMI patients receiving effective cardiac therapies lags behind those with STEMI."

To learn more about this research, please visit:

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The Role of NPs in Expanding Access, Enhancing Revenue

Nurse practitioners (NP) constitute a workforce already grounded in patient-centered care, explains Linda Lindeke, Ph.D., an RN and NP since 1978. Lindeke, who is also associate professor for the School of Nursing and Department of Pediatrics and director of Graduate Studies for the School of Nursing at the University of Minnesota, describes the demographics where an NP might meet resistance, why there's not much mention of the medical home in nursing literature and the impact of the Affordable Care Act's $15 million allocation to fund 10 NP-led clinics that will provide primary care services to the medically underserved.

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Pediatric Obesity Program

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Philip Smeltzer, strategy leader of wellness and health promotion for Humana.

Question: What is Humana's phone-based pediatric obesity program?

Response: The phone-based pediatric program is based on the principle that a child does not control his or her environment, but that an adult does — whether it be a parent, teacher or otherwise. The program aims at intervening with the parent and child. Humana’s pediatric program approaches their population via a phone-based program in combination with the pediatrician. Humana asks the pediatrician to nominate children who are at-risk for obesity. Once nominated, Humana contacts the parents to recruit them into the program. Pediatrician involvement enables Humana to get their foot in the door with the parents.

Once the parent agrees to enroll their child in the program, Humana gives the parents information over the phone and sends them other materials. The parent may then take the lead with the child. Humana does not offer traditional classes or support groups as all of the intervention is phone-based between counselor and parent. Future plans for the pediatric obesity intervention under consideration are e-mail support groups and social networking for parents.

For more information on pediatric obesity programs, please visit:

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Health Incentives Eligibility

Financial and benefits-based incentives are used to promote participation in health and wellness programs. We wanted to see which individuals are eligible for incentives.

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Healthcare Reacts to MRSA Outbreak

Cognizant of the rise in MRSA cases, the Healthcare Intelligence Network conducted a non-scientific online survey to determine what steps healthcare organizations are taking to prevent this infection.

To download this complimentary white paper, please visit:

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IDSA Issues Guidelines for MRSA Infection Treatment

Physicians now have help in their battle against MRSA, a potentially deadly infection that initially was limited to hospitals and healthcare facilities but has become a growing problem in healthy children and adults. The Infectious Diseases Society of America (IDSA) has released its first guidelines, available online, for the treatment of increasingly common MRSA infections. An antibiotic-resistant “superbug,” MRSA is responsible for about 60 percent of skin infections seen in ERs. The guidelines address treatment of these common infections, which are frequently mistaken for spider bites. They also address treatment of invasive MRSA, which is less common but far more serious, including pneumonia and infections of the blood, heart, bone, joints and central nervous system. Invasive MRSA kills about 18,000 people every year. The guidelines are intended to guide physicians in their use of antibiotics for treatment of this common infection. Current treatment varies widely.

As with other IDSA guidelines, the MRSA guidelines will be available in a format designed for iPhones and other mobile devices, and in a pocket-sized quick-reference edition. The IDSA guidelines address a variety of infections caused by MRSA commonly encountered by ER doctors, pediatricians, PCPs, hospitalists, infectious diseases specialists, pharmacists and other healthcare providers. Topics include:

  • How to manage skin and soft tissue infections likely caused by community-associated MRSA (CA-MRSA).
  • How to treat recurrent skin infections.
  • Recommendations regarding use of the intravenous antibiotic vancomycin and other antibiotics used for the treatment of MRSA.
  • How to manage invasive infections, such as pneumonia, and infections in the bones, joints, blood or heart.
  • How to treat newborns who are infected with MRSA.
The guidelines were reviewed and endorsed by the Pediatric Infectious Diseases Society, the American College of Emergency Physicians and the American Academy of Pediatrics. The voluntary guidelines are not intended to take the place of a doctor’s judgment, but rather support the decision-making process, which must be individualized according to each patient’s circumstances. The 13-member guidelines panel comprised of MRSA experts from around the country reviewed hundreds of scientific studies, papers and presentations. IDSA has published more than 50 treatment guidelines on various conditions and infections, ranging from HIV/AIDS to Clostridium difficile.

MRSA is a type of Staphylococcus aureus (“staph”) bacterium that is resistant to first-line antibiotics. Although MRSA can be treated with other types of antibiotics, its resistance to those antibiotics is increasing as well. Overuse and misuse of antibiotics contribute to drug resistance, and the guidelines note that uncomplicated skin infections often can be treated without the use of antibiotics. The guidelines also call for the development of new and better antibiotics to treat invasive MRSA. “MRSA has become a huge public health problem and physicians often struggle with how to treat it,” said the researchers. “The guidelines establish a framework to help physicians determine how to evaluate and treat uncomplicated as well as invasive infections. It’s designed to be a living document, meaning the recommendations will evolve as new information and antibiotics become available.”

MRSA has been a concern in hospitals for decades (hospital-associated MRSA or HA-MRSA), but in the last 15 years, CA-MRSA has become a serious problem among healthy people outside of the hospital. CA-MRSA is often spread in locker rooms, dormitories, jails and prisons, in homes and at daycare centers, usually through direct contact or by an object used by an infected person — such as towels, razors and sports equipment. It most frequently causes painful red, swollen bumps about the size of a pencil eraser or golf ball. These bumps can appear anywhere on the body, most often at the site of a cut or abrasion or areas covered by hair, such as the back of the neck, groin, buttocks and armpits. MRSA is a bigger concern when it invades the body beyond the skin.

An estimated 94,360 invasive MRSA infections occurred in the United States in 2005, and more than 18,000 people who were infected died, according to a large study published in the Journal of the American Medical Association. Most invasive disease was due to HA-MRSA, but about one in seven cases was due to CA-MRSA. Good hygiene is the best defense against MRSA, according to the CDC, including keeping the hands clean, keeping cuts and scrapes clean and covered with a bandage, avoiding contact with other people’s wounds, and avoiding sharing personal items such as towels or razors.

To learn more about this research, please visit:

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Healthcare Case Management in 2011

Targeted case manager interventions across the healthcare continuum are generating significant ROI and positive clinical outcomes resulting from more effective care coordination and reduced health resource consumption. Complete HIN's second annual Survey of the Month on Healthcare Case Management by January 31, 2011 and receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

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