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March 10, 2011 Volume VII, No. 35

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

This week's issue is focused on two types of cancer. Learn the link between skin cancer risk and shift work, as well as the reasons behind breast cancer survivors' increased risk for falls. Also this week, learn seven ways to prevent bloodstream infections in central line patients.

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

This week's DM news:

Table of Contents

  1. Skin Cancer Risk & Shift Work
  2. Breast Cancer & Risk of Falls
  3. Aligning Physician Incentives, Shared Savings
  4. Comorbid Population & Discharge Planning
  5. Targeted Populations for Reducing Readmissions
  6. Medical Homes in 2010
  7. Preventing Bloodstream Infections
  8. Health & Wellness Incentives Use in 2011

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Melanie Matthews, mmatthews@hin.com

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Shift Work May be Associated with Decreased Skin Cancer Risk

In a study by researchers at Brigham and Women’s Hospital (BWH), shift work may be associated with a reduced risk of skin cancer in women. Melatonin is known to have cancer-protective properties, and shift work can induce desynchrony of the circadian system, reducing melatonin production. Shift work has been thought to have important health impacts, with evidence linking shift work to an increased risk of several cancers including breast, endometrial, prostate and colorectal, and non-Hodgkin lymphoma.

The researchers documented 10,799 incidents of skin cancer in 68,336 women in the Nurses’ Health Study over 18 years of follow-up and examined the relationship between rotating night shifts and skin cancer. They found that higher duration of working rotating night shifts was associated with a significantly lower risk of skin cancer. When examining the effect of night shift work on different types of skin cancer, although the risk for each skin cancer (basal cell carcinoma, squamous cell carcinoma and melanoma) decreased, the strongest association was observed for melanoma. Working 10 or more years of rotating night shifts was associated with 44 percent decreased risk of melanoma.

The researchers also found that darker-haired women in the study had the lowest risk of skin cancer. There were no differences in risk by sunlight exposure level at baseline, geographic residence or body location of skin cancer. That the inverse association was strongest among women with dark hair raises the possibility for several mechanistic explanations, including a genetic component that may affect both the extent of melatonin suppression during night work and skin cancer risk. “Although higher melatonin levels appear to be beneficial in individuals with stable circadian rhythms, in shift workers, for certain disease outcomes melatonin suppression may actually be more beneficial,” the researchers concluded.

To learn more about this research, please visit:

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Breast Cancer Survivors at Higher Risk for Falls

The combined effects of chemotherapy and endocrine therapy may increase the risk of bone fractures in breast cancer survivors, according to a study from the Oregon Health & Science University Knight Cancer Institute, Portland. Researchers asked post-menopausal breast cancer survivors whether they had fallen in the past year and then tracked their falls over a six-month study period. They found evidence that women who have survived breast cancer may fall more often than their peers.

Researchers found that 58 percent of breast cancer survivors had experienced a fall in the previous year and almost half (47 percent) fell within six months after joining the study, a rate nearly double the 25 to 30 percent annual fall rate reported for community-dwelling older adults over 65 years of age. Researchers also measured a comprehensive set of neuromuscular and balance characteristics known to be associated with falls in 59 study participants. They found that only balance discriminated breast cancer survivors who fell from those who did not. The study findings also suggest that the balance problems may have been related to changes in the vestibular system that were associated with chemotherapy treatment.

According to the researchers, “Falls in breast cancer survivors are understudied and deserve more attention, particularly in light of the increase in fractures after breast cancer treatment and the relationship of falls to fractures. Our findings add to growing evidence that fall risk is increased in breast cancer survivors and that vestibular function may underpin associations between breast cancer treatment and falls.”

To learn more about this research, please visit:

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HealthPartners Aligns Physician Incentives, Shared Savings with PFP Programs

Money may talk, but after 14 years of administering pay for performance (PFP) programs for its providers and specialists, HealthPartners has figured out what motivates physicians even more than financial incentives. Babette Apland, HealthPartners senior vice president of health and care management, shares this insight, as well as the measures by which HealthPartners evaluates pharmacies and specialists in its PFP program.

To listen to this complimentary HIN podcast, please visit:

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Discharge Planning Strategies for the Comorbid Population

This week's experts are Chad Boult, M.D., M.P.H., M.B.A., professor of public health, medicine and nursing and director of the Lipitz Center for Integrated Health Care at Johns Hopkins Bloomberg School of Public Health; and James Hardy, senior vice president of care management services at McKesson Health Solutions.

Question: Can you describe some discharge planning strategies that might be helpful for a comorbid population?

Response: (Dr. Chad Boult) In our Guided Care model, the nurse doesn’t do the discharge planning. There are some transitional care models where the nurse does do it and every hospital has to have a discharge planner, but we rely on that person to make the plan. Our nurse interacts with that person to make sure that person knows everything they need to know about this patient for whom they’re making the plan. Most discharge planners have no idea of the patient’s home circumstances. However, our nurse has been to the home and makes sure the planners know the capabilities at home and tries to ensure that a good plan is made. Importantly, our nurses visit the home the day of or day after discharge. That’s when the opportunity is greatest to resolve the confusion that’s almost always going on in people who have complicated problems, have had their medications adjusted and then are sent home.

(James Hardy) We’re working on a program in our Illinois program where we’ve embedded a nurse care manager in 12 local hospitals in Illinois, where we’re identifying individuals who are already enrolled in our DM program who have been admitted, and trying to create a linkage between what discharge planners are looking at and giving them more information about how those consumers are currently accessing services. They are relating early on that we’re going to get them back when they discharge. It’s augmenting the discharge planning function at the hospital, helping them identify, “These are where services are being provided.” And the other thing that we’re being able to do in Illinois is, by and large the discharge planners at the hospitals, one of their weakest areas are identifying behavioral health resources, particularly for Medicaid consumers. Our ability to provide more information and access to those services is critical for the individuals with behavioral health comorbidity.

For more information on comorbidity care models, please visit:

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Healthcare Performance Benchmarks delivers a new chart each week derived from the latest healthcare market research — metrics and trends in telehealth, case management, reducing readmissions and avoidable ER use, health coaching, medical home, and many other areas.

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Top Targeted Populations for Reducing Readmissions

Many healthcare organizations are taking a hard look at readmission trends in their populations and launching programs to reduce hospital readmission rates. We wanted to see which populations organizations are targeting to reduce hospital readmissions.

Click here to view the chart.

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Healthcare Transparency: Medical Homes in 2010 — Awareness, Adoption, Tools and Outcomes

Patient-centered medical home (PCMH) pilots are in high gear around the country and high on the healthcare reform agenda. This white paper from the Healthcare Intelligence Network (HIN) measures adoption of the PCMH as compared to our first medical home survey in 2006, the targeted populations that would benefit from this model of care, the components of a medical home and the effects of this model in the healthcare industry.

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7 Ways to Prevent Bloodstream Infections in Central Line Patients

Bloodstream infections in patients with central lines can be deadly, killing as many as one in four patients who gets one, according to the CDC. To prevent bloodstream infections in patients with central lines, hospitals, dialysis centers and other medical care locations can do the following:

  • Make sure CDC infection control guidelines are followed every time a central line is put in and used.
  • Encourage staff members to speak up when guidelines aren't followed.
  • Use data for action. Track infection rates and germ types with CDC's National Healthcare Safety Network (NHSN) to learn where and why infections are happening, target actions to stop them and track progress.
  • Recognize staff members or units that work hard to prevent central line infections or that solve issues with infection control.
  • Join state-based prevention programs such as the AHRQ-funded expansion of On the CUSP: Stop BSIs.
Patients with central lines and their caregivers can prevent bloodstream infections by:
  • Asking their doctors and nurses to clean their hands before and after touching patients.
  • Asking which infection prevention methods will be used, why a central line is needed and how long it will be in, and to tell a nurse or doctor if the area around the central line becomes sore or red, or if the bandage falls off or looks wet or dirty.
The number of bloodstream infections in ICU patients with central lines decreased by 58 percent in 2009 compared to 2001, according to a new CDC Vital Signs report. During these nine years, the decrease represented up to 27,000 lives saved and $1.8 billion in excess healthcare costs. In addition to the ICU findings, the report found that about 60,000 bloodstream infections in patients with central lines occurred in non-ICU healthcare settings such as hospital wards and kidney dialysis clinics. About 23,000 of these occurred in non-ICU patients (2009) and about 37,000 infections occurred in dialysis clinics patients (2008).

A central line is a tube usually placed in a large vein of a patient's neck or chest to deliver treatment in an ICU, elsewhere in the hospital and during dialysis. A bloodstream infection can happen when germs enter the blood through a central line, often because proper procedures were not used while the central line was placed or maintained. In recent years, studies have proven that healthcare providers can prevent most bloodstream infections in patients with central lines by following CDC infection control recommendations, which include removing central lines as soon as medically appropriate. In hemodialysis patients, central lines should only be used when other options are unavailable. Infections are one of the leading causes of hospitalization and death for hemodialysis patients. At any given time, about 350,000 people are receiving hemodialysis treatment for kidney failure. Seven in 10 patients who receive dialysis begin that treatment through a central line.

To learn more about this research, please visit:

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Health & Wellness Incentives Use in 2011

Healthcare companies have grown increasingly creative in their use of incentives to drive engagement and participation in health and wellness programs. Please share your experiences with incentives by completing HIN's third annual survey on this topic by March 31, 2011. You'll receive a free executive summary of the compiled results, and your responses will be kept strictly confidential.

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