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February 3, 2011 Volume VII, No. 30

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

What's behind the rise in the number of Americans with diabetes and prediabetes? Find out the answer in this week's issue, as well as the effects of diabetes on both patients and their spouses. Also, learn about a Michigan initiative that is reducing healthcare-associated infections and deaths in ICUs.

Looking for ways to improve the health of your population? Check out HIN's new blog post on 29 recommendations to lead a healthy life from the USDA 2010 Dietary Guidelines.

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

This week's DM news:

Table of Contents

  1. Increase in Diabetes, Prediabetes
  2. Diabetes Affects Patients & Spouses
  3. Embedded Case Manager
  4. 3 Keys to a Successful Wellness Program
  5. Case Manager Work Locations
  6. Benchmarks in Patient Education
  7. Reducing HAIs in ICUs
  8. Accountable Care Organizations in 2011

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Publisher:
Melanie Matthews, mmatthews@hin.com

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Americans with Diabetes Rises to Nearly 26 Million

Nearly 26 million Americans have diabetes, according to new CDC estimates, up from 23.6 million in 2008. In addition, an estimated 79 million U.S. adults have prediabetes, a condition in which blood sugar levels are higher than normal, but not high enough to be diagnosed as diabetes.

In 2008, the CDC estimated that 57 million adults had prediabetes. Prediabetes raises a person's risk of type 2 diabetes, heart disease and stroke. Diabetes affects 8.3 percent of Americans of all ages, and 11.3 percent of adults aged 20 and older, according to the National Diabetes Fact Sheet for 2011. About 27 percent of those with diabetes — 7 million Americans — do not know they have the disease. Prediabetes affects 35 percent of adults aged 20 and older.

The 2011 estimates have increased for several reasons:

  • More people are developing diabetes.
  • Many people are living longer with diabetes, which raises the total number of those with the disease. Better management of the disease is improving cardiovascular disease risk factors and reducing complications such as kidney failure and amputations.
  • Hemoglobin A1c is now used as a diagnostic test, and was therefore incorporated into calculations of national prevalence for the first time. The test, also called glycated hemoglobin, measures levels of blood glucose (sugar) over a period of two to three months. Because of this change, estimates of populations with diabetes and prediabetes in the 2011 fact sheet are not directly comparable to estimates in previous fact sheets.
In a study published last year, the CDC projected that as many as one in three U.S. adults could have diabetes by 2050 if current trends continue. Type 2 diabetes, in which the body gradually loses its ability to use and produce insulin, accounts for 90 percent to 95 percent of diabetes cases. Risk factors for type 2 diabetes include older age, obesity, family history, having diabetes while pregnant (gestational diabetes), a sedentary lifestyle and race/ethnicity. Groups at higher risk for the disease are African-Americans, Hispanics, American Indians/Alaska Natives, and some Asian-Americans and Pacific Islanders. Other data from the 2011 fact sheet include:
  • About 215,000 Americans younger than age 20 have diabetes. Most cases of diabetes among children and adolescents are type 1, which develops when the body can no longer make insulin.
  • An estimated 1.9 million Americans were diagnosed with diabetes in 2010.
  • Racial and ethnic minorities continue to have higher rates of diabetes after adjusting for population age differences. For adults, diabetes rates were 16.1 percent for American Indians/Alaska Natives, 12.6 percent for blacks, 11.8 percent for Hispanics, 8.4 percent for Asian-Americans and 7.1 percent for non-Hispanic whites.
  • Half of Americans aged 65 and older have prediabetes, and nearly 27 percent have diabetes.
Diabetes is the seventh leading cause of death in the United States. People with diabetes are more likely to suffer from complications such as heart attacks, strokes, high blood pressure, kidney failure, blindness and amputations of feet and legs. Diabetes costs $174 billion annually, including $116 billion in direct medical expenses. The CDC is working on the National Diabetes Prevention Program, which is based on the NIH-led Diabetes Prevention Program research study and aimed at helping people reduce their risk for developing type 2 diabetes.

To learn more about this research, please visit:
http://www.cdc.gov/media/releases/2011/p0126_diabetes.html

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Diabetes Affects Older Patients', Spouses' Well-being

Older patients with diabetes who are not dealing well with the disease are likely to have symptoms of depression, and spouses of older patients also suffer distress related to diabetes and its management, according to research from Purdue University. The findings are based on statistical models with 185 couples older than 50. The patients and spouses completed individual surveys that measured distress related to diabetes, such as adherence to treatment recommendations, as well as depressive symptoms. Gender effects were measured by comparing the couples' responses. There were 67 female patients and 118 male patients, and each couple was screened to make sure only one person had diabetes.

Researchers found that the distress spouses feel is similar to what patients feel, and this could contribute to their own depressive symptoms such as irritability or sadness. These depressive symptoms come from their own anxieties about living with the disease or caring for someone with the disease and not necessarily because the other person is struggling. Researchers also found that when male patients were concerned about the management of their diabetes, their depressive symptoms were elevated more than those for female patients with similar levels of concerns. "This gender difference is consistent with prior work showing that male patients who are not managing their disease well tend to experience greater depressive symptoms," said the researchers. "And while we saw this difference between male and female patients, we did not see the same pattern of distress between their respective spouses. This is surprising, because one might assume that the spouse would be as worried, or, according to family roles, that wives might worry more. However, more research, especially long-term observations, is needed."
"Because spouses' distress is not always directly linked to feelings of their partner, it tells us that we need to pay more attention to the spouse as well as the patient," said the researchers. "Understanding the triggers for depressive symptoms can help practitioners and experts better care for patients and spouses as individuals and as a unit. We also found that many people reported some depressive symptoms, and some reported levels indicative of risk for clinical depression. It's important to consider depressive symptoms because they may signal concerns and problems that could be alleviated with treatment."

Diabetes is managed daily through diet, exercise and medications. Complications, such as poor blood circulation, vision impairment, heart disease and stroke, are possible if the disease is not managed. In this study, spouses often reported that the disease's daily management as well as the fear of their loved one's living with diabetes were common concerns.

Diabetes affects about one in five Americans over the age of 60, and the majority of those people have Type 2 diabetes, which is a disease of the endocrine system. Type 2 diabetes, also referred to as adult-onset diabetes, is caused by insufficient secretion of insulin and resistance to insulin, which is problematic because it lessens the ability of cells to absorb glucose from the bloodstream. The incidence of the disease, which is considered a leading cause of death, is increasing as more people are overweight and sedentary.

To learn more about this research, please visit:
http://www.purdue.edu/newsroom/research/2011/...

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Contributions of the Embedded Case Manager

The contributions of an embedded case manager to the practice quickly become evident, explains Diane Littlewood, R.N., regional manager of case management for health services, Geisinger Health Plan, which in turn bolsters physician buy-in for the program. She explains how to ensure that health plan and provider expectations for embedded case management are met.

To listen to this complimentary HIN podcast, please visit:
http://www.hin.com/podcasts/podcast.htm#113

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3 Keys to a Successful Wellness Program

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Lynette Phillips, director of population health support for Healthways.

Question: What are the three main components of a wellness program?

Response: Data collection is an important component of any wellness program. Sometimes data collection comes in the form of a health risk assessment (HRA). This provides self-reported data only, where the participantsí perception of their health is reported through their responses to a questionnaire. There is also a health fair study where finger sticks are administered to a voluntary group to gather glucose and lipid levels. Our program provides data collection in the form of blood labs and biometrics. Through this method, objective and verifiable data is gathered, and participants can be provided with an accurate perception of their health.

The second component of a wellness program is intervention. Intervention is following up on the data collection results and providing participants with the information to encourage them to take care of any identified risk factors. Intervention might take the form of content, which is educational pieces or online tools made available to the participant. Other forms of intervention are self-directed or a coaching model, which is a one-on-one, outbound call to the participant to encourage appropriate action.

The final component of a wellness program is scoring and incentive. It is important to remember that HRA scoring is self-reported data. Therefore, it might not provide the most accurate picture of what is occurring with the participant. It is more accurate to score based on the medical exam or verifiable data. This will provide the participant with realistic and accurate information to allow them to set goals and identify risk factors.

For more information on wellness programs and HRA use, please visit:
http://store.hin.com/product.asp?itemid=4110

We want to hear from you! Submit your question for Disease Management Q&A to info@hin.com.

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Top 5 Case Manager Work Locations

Case managers' influence has expanded beyond the health plan office to primary care offices, hospital halls, long-term care facilities, and provider or home health visits. We wanted to see how many healthcare organizations are embedding case managers at care sites and which care sites merit the most case manager effort.

Click here to view the chart.

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Benchmarks in Patient Education: Prevention, Self-Care Top Lessons

How prevalent are patient and member education programs, and which health areas are addressed by these efforts? How are healthcare organizations delivering health education, and who is the primary health educator? What is the chief impact of patient education programs, and how do organizations measure ROI? The Healthcare Intelligence Network set out to answer these questions and others during its 2009 Patient Education and Outreach Benchmarks e-survey. This executive summary of responses from 134 healthcare organizations offers lessons in the value of educating patients and members about DM and self-care.

To download this complimentary white paper, please visit:
http://www.hin.com/library/registerpeo.html

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Michigan ICUs Reduce HAIs, Cut Deaths Among Medicare Patients

Older Americans treated in Michigan ICUs were less likely to die while hospitalized than similar ICU patients in other Midwestern hospitals, according to a new study evaluating an innovative quality improvement initiative funded by HHS' AHRQ. The Keystone Project targeted ways to reduce the number of healthcare-associated infections (HAIs). Previous research has shown that targeted quality improvement programs can reduce HAI rates. This study is the first to link these programs to reduced death rates.

Researchers analyzed Medicare data for ICU patients in Michigan hospitals and 364 hospitals in 11 other Midwestern states. They looked at data before the project was initiated, while it was being phased in, and up to 22 months after implementation. The researchers found that overall a person's chance of dying decreased by about 24 percent in Michigan after the program was implemented compared to only 16 percent in surrounding Midwestern states where the program was not implemented.

According to the CDC, HAIs are one of the most common complications of hospital care, accounting for an estimated 1.7 million infections and 99,000 associated deaths in 2002. These infections are responsible for $28 to $34 billion in preventable healthcare expenses every year. Infectious agents, such as bacteria, found in healthcare settings can cause patients to develop HAIs when they have surgery or require central lines or urinary tract catheters.

The Keystone Project uses a comprehensive approach that includes promoting a culture of patient safety, improving communication among ICU staff teams and implementing practices based on guidelines by the CDC, such as checklists and hand washing, to reduce rates of catheter-related bloodstream infections and ventilator-associated pneumonia. The AHRQ continues to support the Keystone Project through a contract with the Health Research & Educational Trust, an affiliate of the American Hospital Association, by reaching more hospitals and other settings in addition to ICUs and applying the approach to various HAIs. The Keystone Project is part of a department-wide effort to address HAIs.

To learn more about this research, please visit:
http://www.ahrq.gov/news/press/pr2011/haimiicupr.htm

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Accountable Care Organizations in 2011

Accountable care organizations (ACOs) create integrated delivery systems that encourage teams of physicians, hospitals and other providers to collaboratively coordinate care for ACO members. To learn more about this emerging trend, complete HIN's survey on accountable care organizations and get a FREE executive summary of the compiled results. More than 50 healthcare organizations have already responded!

To participate in this survey and receive its results, please visit:
http://www.surveymonkey.com/s/acos

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