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February 17, 2011 Volume VII, No. 32

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

Do diabetes Web sites offer quality information about the disease? Find out in this week's issue, and learn about the different ways to delay and prevent diabetes suggested by the American Diabetes Association.

Also this week, learn about the link between berry consumption and Parkinsonís disease.

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

This week's DM news:

Table of Contents

  1. Diabetes & Social Network Quality
  2. Parkinsonís Risk & Berries
  3. Avoidable ER Visits
  4. Health Improvement Programs & IT
  5. Top 5 Medical Home Reimbursement Models
  6. Benchmarks in Health & Wellness Incentives
  7. Ways to Delay, Prevent Type 2 Diabetes
  8. Accountable Care Organizations in 2011

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Please send comments, questions and replies to jpapay@hin.com.

Melanie Matthews, mmatthews@hin.com

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Quality Varies in Social Networking Web sites for Diabetics

According to a study of 10 diabetes Web sites performed by researchers in the Children's Hospital Boston Informatics Program, there are large variations in quality and safety for many diabetes Web sites, with room for improvement. As reported from the Journal of the American Medical Informatics Association, only 50 percent of the sites presented content consistent with diabetes science and clinical practice. Even fewer offered both scientific accuracy and patient protections such as safeguarding of personal health information, effective internal and external review processes and appropriate advertising. For instance, seven of the 10 sites did not allow members to restrict the visibility of their profiles, five carried advertisements that were not labeled as such and three sites went as far as to advertise unfounded "cures."

The team evaluated diabetes Web sites that appeared prominently in Google searches and allowed members to create personal profiles and interact with each other. They looked at four key factors:

  • Agreement of content with diabetes science and clinical practice standards.
  • Practices for auditing content and supporting transparency.
  • Accessibility and readability of privacy policies.
  • The degree of control members had over the sharing of personal data.
The average number of members per Web site was 6,707. Activity ranged widely among the sites, from over 100 new posts per day to less than five new posts per day. The majority of sites studied did not include a disclaimer encouraging patients to discuss their care regimen with a healthcare provider. Many sites also missed opportunities to communicate essential diabetes information, such as the definition of A1c.

In addition to recommending improvements in these areas, the authors saw a need for increased moderation, for the credentials of moderators to be more visible and for periodic external review. Further, potential conflicts of interest — such as ties to the pharmaceutical industry — needed to be more clearly disclosed, and privacy policies easier to understand.

Diabetes is only one illness in the rapidly growing list for which there are online social networks with thousands of users. The researchers for this study chose to study diabetes-related networks because they were among the earliest to emerge and remain among the most active. They and colleagues in the Children's Hospital Informatics Program are further studying how these sites are used — how people choose to interact with them and how specifically they share their medical information. Last year, Elissa Weitzman, ScD, MSc, an assistant professor in the laboratory of Kenneth Mandl, MD, MPH, along with Dr. Mandl, developed an application for the social networking Web site TuDiabetes that allows users to submit their A1c levels to be displayed in a worldwide map, as part of an effort to encourage diabetes management and inform public health efforts and research. Weitzman and Dr. Mandl believe that the emergence of online health communities and their large number of participants reveal unmet needs for information and support of patients and families.

To learn more about this research, please visit:

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Eating Berries May Lower Risk of Parkinsonís

New research from the American Academy of Neurology shows that men and women who regularly eat berries may have a lower risk of developing Parkinsonís disease, while men may also further lower their risk by regularly eating apples, oranges and other sources rich in dietary components called flavonoids. Flavonoids are found in plants and fruits and are also known collectively as vitamin P and citrin. They can also be found in berry fruits, chocolate and citrus fruits such as grapefruit.

The study involved 49,281 men and 80,336 women. Researchers gave participants questionnaires and used a database to calculate the intake amount of flavonoids. They then analyzed the association between flavonoid intakes and risk of developing Parkinsonís disease. They also analyzed consumption of five major sources of foods rich in flavonoids: tea, berries, apples, red wine and oranges or orange juice. The participants were followed for 20 to 22 years.

During the study time, 805 people developed Parkinsonís disease. In men, the top 20 percent who consumed the most flavonoids were about 40 percent less likely to develop Parkinsonís disease than the bottom 20 percent of male participants who consumed the least amount of flavonoids. In women, there was no relationship between overall flavonoid consumption and developing Parkinsonís disease. However, when sub-classes of flavonoids were examined, regular consumption of anthocyanins, which are mainly obtained from berries, were found to be associated with a lower risk of Parkinsonís disease in both men and women. ďOur findings suggest that flavonoids, specifically a group called anthocyanins, may have neuroprotective effects. If confirmed, flavonoids may be a natural and healthy way to reduce your risk of developing Parkinsonís disease,Ē according to the researchers.

To learn more about this research, please visit:

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Avoidable ER Visits — Reduction and Prevention Benchmarks

How are healthcare organizations encouraging appropriate use of the emergency room in their populations?

In this month's healthcare benchmarks podcast, Healthcare Intelligence Network executive VP and COO Melanie Matthews shares metrics from HIN's July 2010 survey on reducing avoidable ER visits, with relevant commentary from Dr. Barsam Kasravi, managing medical director for state-sponsored programs at WellPoint; and Sara Tracy, senior manager of emergency services at Kaiser Foundation Health Plan of Colorado.

To listen to this complimentary HIN podcast, please visit:

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How to Engage Health Improvement Program Participants Without Computer Access

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's experts are Randall Williams, MD, F.A.C.C., chief executive officer with Pharos Innovations, and Thomas Kline, MD, medical director at the Iowa Medicaid Enterprise.

Question: If participants in health improvement programs do not have computer access and the program relies on technology to engage the participant, what is the alternative? How do you address the patient population that does not have Web access for self-reporting or daily compliance via the Internet? Are there populations that are less engaged or less compliant because of this issue?

Response: (Dr. Randall Williams) We utilize daily self-reporting technology that the member or patient can access through whichever communication mode they prefer. In most cases, thatís going to be a phone and interestingly, itís not always the same phone. It might be a phone at the office one day and a phone at home another day. Likewise, it might be a cell phone instead of a land line. Even in the case of a cell phone, it might not be the same cell phone one month to the next, as many of the individuals in these programs switch phone services frequently. We offer the population an opportunity to engage in the daily self-reporting using whichever technology they find easy to use. What that means for us in the engagement process though, is that we still need to have accurate contact information to find them and to reach them. That also means that once we have located them, we tend to know exactly who is changing phones, who is moving or who has updated contact information because once they are involved everyday, we have a touch point with them.

(Dr. Thomas Kline) Our Medicaid program was entirely telephonic. It had to be simple, and it had to be something that our membership could use without any difficulty — the technology challenge. Even a cell phone was a challenge for some people. It could have been their cell phone today and a neighborís cell phone tomorrow. We even encourage people to go to the local public health offices if they need to use that phone. Unfortunately, we werenít able to provide some of these members with a phone because we found that it might affect their eligibility, and we didnít want that to occur.

For more information on health improvement and IT, please visit:

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

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Top 5 Medical Home Reimbursement Models

The patient-centered medical home can deliver quality care at little or no added cost while improving patient and provider satisfaction. We wanted to see the top reimbursement models being used in medical homes.

Click here to view the chart.

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2010 Benchmarks in Health & Wellness Incentives Use

The use of economic incentives to drive engagement and results from wellness and prevention programs continues to proliferate. This executive summary captures responses of 139 healthcare organizations to HIN's second annual Health and Wellness Incentives Use e-survey on the focus, utilization and impact of health and wellness incentives, from types of incentives offered to methods for identifying individuals for incentive programs and reasons for providing incentives.

To download this complimentary white paper, please visit:

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7 Ways to Delay or Prevent Type 2 Diabetes

According to new data from the CDC, nearly 26 million children and adults in the United States are now living with diabetes. With one out of every three Americans at high risk for type 2 diabetes, emphasis must be placed on prevention and lifestyle modifications that can delay or prevent type 2 diabetes, a debilitating disease that can lead to blindness, kidney failure, heart disease and death. The American Diabetes Association is offering tips to help prevent or delay the development of type 2 diabetes and its complications:

  • Know Your Risk. There are certain risk factors you canít change, including being over 45 years of age, a family history of diabetes or coming from a certain family background (African American, American Indian, Asian American or Pacific Islander, or Hispanic/Latino). Risk factors that can be controlled include being overweight or inactive, eating an unhealthy diet, smoking or having higher than normal blood glucose, blood pressure or cholesterol levels.
  • Get a Check-Up. Donít wait until you get sick to see your healthcare provider. Schedule a complete evaluation to learn your numbers, including:
    • Blood glucose —- There are three different tests that measure blood glucose levels: A1c, Fasting Plasma Glucose (FPG) and Oral Glucose Tolerance Test (OGGT). These tests will determine if prediabetes or diabetes is present.
    • Blood pressure level —- A healthy blood pressure level is below 120/80. Early high blood pressure is between 120/80 and 140/90. High blood pressure is 140/90 and higher.
    • Blood lipid levels —- A blood lipid test measures HDL (good) cholesterol, LDL (bad) cholesterol and triglycerides. To maintain optimal health, it is important to be aware of your lipid levels and to maintain low LDL cholesterol levels.
  • Move Those Feet. Experts suggest exercising 30 minutes a day most days of the week. If exercising that long is intimidating at first, try walking 10 minutes most days of the week. Find other ways to be more active, such as taking the stairs and parking further away.
  • Sneak in Healthy Foods. Instead of making a complete lifestyle change, try incorporating one small change into your diet at a time. Choose lower-calorie snacks, eat a salad and a vegetable with dinner, or take home half of your main course when you eat out.
The American Diabetes Association also offers free resources for those at risk for type 2 diabetes:
  • My Health Advisor — Calculate your risk for type 2 diabetes and heart disease by entering some basic health information. After your risk is calculated, you can quickly and easily see the difference simple lifestyle changes — like losing 10 pounds or quitting smoking — can make in your overall risk.
  • CheckUp America — Get in-depth information about the different risk factors associated with type 2 diabetes and what can be done to lower that risk.
  • Center for Information and Community Support — By calling 800-DIABETES or chatting with a representative online, you can request free information in English and Spanish, including the new booklet Top 5 Ways to Stop Diabetes and Get Healthy Right Now!
Early diagnosis of type 2 diabetes is critical to successful treatment and delaying and preventing some of its complications. For many, diagnosis may come seven to 10 years after the actual onset of diabetes, often only after patients have already started to show signs of one or more of its complications. Studies have shown that exercising 150 minutes a week and losing 7 percent of your body weight (about 15 pounds if you weigh 200 pounds), can prevent or delay type 2 diabetes by 57 percent.

To learn more about this research, please visit:

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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 210 healthcare organizations have already responded!

To participate in this survey and receive its results, please visit:

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