Disease Management Update
Volume V, No. 41
February 26, 2009
Dear Healthcare Intelligence
While stroke is largely a disease suffered by the elderly — for each decade after age 55, the risk of stroke doubles — healthcare professionals cannot discount entirely the possibility of stroke in children and young adults. In this week's DM Update, one study shows that many young adults suffering stroke are being misdiagnosed in the ER, while another notes a correlation between the occurrence of stroke and the number of fast-food restaurants in a neighborhood.
Your colleague in the business of healthcare,
Editor, Disease Management Update
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Table of Contents
- Young Adult Stroke Patients May be Misdiagnosed in ER
- Disease Management Q&A: Moving into New Marketing Arenas
- HealthSounds: Improving Patient Engagement for Lasting Behavior Change
- Number of Fast-Food Restaurants Can Supersize Stroke Risk
- Survey of the Month: Health & Wellness Incentives Utilization
- Changing Lives with Lifestyle Management
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1. Young Adult Stroke Patients May be Misdiagnosed in ER
Young adults with stroke symptoms are sometimes misdiagnosed in ERs — making them miss effective early treatment — according to research presented at the American Stroke Association’s International Stroke Conference 2009. Researchers reviewed data on 57 patients, ages 16 to 50 years old, enrolled since 2001 in the Young Stroke Registry at the Comprehensive Stroke Center at Wayne State University in Detroit, Mich.
Four males and four females (14 percent), average age 34, were misdiagnosed as having vertigo, migraine, alcohol intoxication or other conditions. They were discharged from the hospital and later discovered to have suffered a stroke. Those misdiagnosed included an 18-year-old man who reported numbness on his left side but was diagnosed with alcohol intoxication, a 37-year-old woman who arrived with difficulty speaking and was diagnosed with a seizure and a 48-year-old woman with sudden blurred vision, an off-balance walk, lack of muscle coordination, difficulty speaking and weakness in her left hand, who was told she had an inner ear disorder.
“Accurate diagnosis of stroke on initial presentation in young adults can reduce the number of patients who have continued paralysis and continued speech problems,” said Seemant Chaturvedi, M.D., senior author of the study and a professor of neurology and director of the stroke program at Wayne State. “We have seen several young patients who presented to emergency rooms with stroke-like symptoms within three to six hours of symptom onset, and these patients did not get proper treatment due to misdiagnosis. The first hours are really critical.”
Intravenous delivery of the clot-busting drug tissue plasminogen activator (tPA) is the only U.S. government-approved treatment for acute stroke. It must be delivered within three hours of symptom onset to reduce permanent disability caused by stroke. Dr. Chaturvedi said experimental interventional stroke treatment such as intra-arterial clot busters and mechanical clot retrieval may be an option for some patients three to eight hours after symptoms.
“Part of the problem is that the emergency room staff may not be thinking stroke when the patient is under 45 years old,” Dr. Chaturvedi said. “Physicians must realize that a stroke is the sudden onset of these symptoms. Some people believe that younger people may respond better to stroke treatments, so that makes it doubly important to recognize when a stroke is happening. After 48 to 72 hours, there are no major interventions available to improve stroke outcome.”
Patients arriving with “seemingly trivial symptoms like vertigo and nausea” should be assessed meticulously, he said.
To learn more about this research, please visit:
Disease Management Q&A: Moving into New Marketing Arenas
Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Scott Schroeder, former president and CEO of Cohorts Inc.
Question: Which new arenas are proving to be effective marketing locations for Gen X and Gen Y? Would you be looking at the Internet, TV, radio, billboards or subway ads?
Response: (Scott Schroeder) Besides the Internet and podcasts, one thing they have in common is virtually all of them own a cell phone. So why not create an environment where in your advertising campaigns, for example, you can text these five digits and get more information about our healthcare facility or about our insurance provider? That kind of messaging and that kind of communication is very valuable.
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HealthSounds Podcast: Improving Patient Engagement in Telephonic and Online Health Improvement Programs for Lasting Behavior Change
The daily engagement of Medicaid beneficiaries in self-care health monitoring programs can help healthcare organizations avoid many of the challenges inherent in working with this frequently underserved population, explains Pharos Innovations CEO Dr. Randall Williams. Once participants are identified, they are very receptive to the daily contact, which has resulted in extremely high program engagement rates.
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Number of Fast-Food Restaurants Can Supersize Stroke Risk
Researchers at the University of Michigan (U-M) have found that the risk of stroke increases with the number of fast-food restaurants in a neighborhood. In the study, residents of neighborhoods with the highest number of fast-food restaurants had a 13 percent higher relative risk of suffering ischemic strokes than those living in areas with the lowest number of restaurants. The relative risk of stroke increased 1 percent for each fast food restaurant in a neighborhood.
The stroke risk association emerged from data gathered in the ongoing Brain Attack Surveillance in Corpus, Christi (BASIC) project, which has identified strokes occurring in Nueces County, Texas, since Jan. 1, 2000. The report examined 1,247 ischemic strokes that occurred from the study’s start through June 2003.
While this data implies that neighborhoods with large numbers of fast food restaurants are prime areas for stroke prevention programs, additional research is needed to confirm correlation. It is still unknown whether strokes are caused by what's on the menu, or if restaurants are markers for unhealthy neighborhoods.
To learn more about this research, please visit:
Survey of the Month: Health & Wellness Incentives Utilization
As more healthcare purchasers and payors use rewards and incentives to drive participation and engagement in health and wellness programs, the industry has noted recent dramatic shifts in incentives use, preferred reward types and the activities for which incentives are offered. Please share your organization's experiences with health incentives and rewards by completing HIN's Survey of the Month by February 28. You'll receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.
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6. Changing Lives with Lifestyle Management: Taking the Pulse of Population Health Programs
Abandoning behaviors that are detrimental to one’s health is no simple feat. That's why numerous healthcare organizations are launching lifestyle management programs for individuals with life-threatening conditions such as diabetes, heart disease and obesity. This executive summary provides the general character of more than 60 such initiatives, including the differing approaches and techniques in identification, treatment and outcome assessment.
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