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March 17, 2011 Volume VII, No. 36

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

Can a collaborative care program help manage depression in heart disease patients? Find out in this week's issue, along with three ways to reduce gaps in prevention use among elderly and diverse populations.

At the halfway point of this month's survey on health and wellness incentives, the completion of a health risk assessment is the top health improvement activity incented by respondents. To receive a free e-summary of the results, complete the survey by March 31, 2011. Your responses will be kept strictly confidential.

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

This week's DM news:

Table of Contents

  1. Collaborative Care Program for Heart Patients
  2. Where's the U.S. Diabetes Belt?
  3. Measuring ACO Activity
  4. Pharmacist in the Diabetes Medical Home
  5. Penalties for HRA Refusals
  6. 2011 Benchmarks in Healthcare Case Management
  7. Clinical Prevention Services Gaps
  8. Health & Wellness Incentives Use 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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Collaborative Care Program Reduces Depression in Heart Disease Patients

Participants in the first hospital-initiated, low-intensity collaborative care program to treat depression in heart patients showed significant improvements in their depression, anxiety and emotional quality of life after six and 12 weeks, researchers report in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal. Depression is a common condition in cardiovascular disease (CVD) patients, which can result in poor prognosis and quality of life. Collaborative care depression management programs use a non-physician care manager to coordinate depression evaluation and treatment among the patient, primary medical physician and a psychiatrist.

In the trial, researchers randomized 175 depressed heart patients to either “usual care” (a recommendation for depressive treatment) or “collaborative care,” which includes receiving written and verbal education about depression and its impact on cardiac disease, scheduling pleasurable leisure activities post-discharge, receiving detailed treatment options (medicines or counseling referral) and coordinating follow-up care after discharge.

Six weeks after leaving the hospital, nearly twice as many of the collaborative care patients reported their depression symptoms were cut by half or more, compared to those receiving usual care (59.7 versus 33.7 percent). The differences at 12 weeks were also improved with a 51.5 percent depression response rate for collaborative care patients versus 34.4 percent for patients receiving usual care. Those effects decreased once the intervention ended at 12 weeks and between group differences lost their statistical significance by the six-month follow-up call, which came three months after the patients’ last contact with the researchers. Although rehospitalization rates were similar between groups, the collaborative care patients’ self-reported significantly fewer and less severe cardiac symptoms and better adherence to healthy activities like diet and exercise at six months compared to the usual care group. "These improvements are relevant medical outcomes in themselves, and suggest this type of program may have broad effects on overall health," said the researchers. Those in the collaborative care group received only a little more attention — three phone calls at most and stronger recommendations from their doctors — than those in the usual care group, which is a less intense follow-up.

The study is a first-step for hospital-initiated collaborative care, said the researchers. "While improved mental health is a start, a program may require more intensity to see improved medical outcomes. Patients with heart disease who have depression are more likely to be rehospitalized, have poorer quality of life and are more likely to die from their heart disease than are people without depression. If an efficient program like this one can be used to identify, treat and monitor depression in heart disease patients, this might lead to lower rates of rehospitalization or death in these patients." The American Heart Association recommends that CVD patients be screened for depression and receive coordinated follow-up care for heart disease and depression if they have both conditions.

To learn more about this research, please visit:

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Diabetes Belt Identified in Southern United States

A cluster of high prevalence areas or a "diabetes belt" of 644 counties has been identified in 15 mostly southeastern U.S. states using estimates of the prevalence of diagnosed diabetes for every U.S. county, according to an article published in the American Journal of Preventive Medicine. The diabetes belt includes portions of Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia and West Virginia, as well as the entire state of Mississippi.

Nearly one third of the difference in diabetes prevalence between the diabetes belt and the rest of the United States is associated with sedentary lifestyle and obesity. Thirty percent of the excess risk was associated with modifiable risk factors, and 37 percent with non-modifiable factors, such as age and race/ethnicity. Data from the diabetes belt showed prevalence rates greater than 11.0 percent or higher. By comparing demographics and risk factors such as gender, age, education, sedentary lifestyle, obesity and race/ethnicity, they found four factors that distinguished the diabetes belt from the rest of the country:

  • Population of the diabetes belt counties contained substantially more non-Hispanic African Americans compared to the rest of the country (23.8 percent for the diabetes belt, 8.6 percent for the rest of the country).
  • Prevalence of obesity (32.9 versus 26.1 percent) was greater in the diabetes belt than in the rest of the United States.
  • Sedentary lifestyle (30.6 versus 24.8 percent) was greater in the diabetes belt than in the rest of the United States.
  • Proportion of people with a college degree was smaller (24.1 versus 34.3 percent).
"Identifying a diabetes belt by counties allows community leaders to identify regions most in need of efforts to prevent type 2 diabetes and to manage existing cases of the disease," said the study researchers. "Community design that promotes physical activity, along with improved access to healthy food, can encourage the healthy lifestyle changes that reduce the risk of developing type 2 diabetes."

To learn more about this research, please visit:

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Measuring ACO Activity

Are accountable care organizations (ACOs) the new wave of healthcare delivery?

In this month's healthcare performance benchmarks podcast, Healthcare Intelligence Network's Melanie Matthews analyzes the industry's activity and participation in accountable care organizations derived from HIN's February 2011 survey results. Jeffrey Ruggiero, Esq., advises ACO participants to prepare for the legal and regulatory hurdles.

To listen to this complimentary HIN podcast, please visit:

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A Pharmacist's Role in the Diabetes Medical Home

This week's expert is Roberta Burgess, RN, nurse case manager for Community Care Plan of Eastern Carolina with Heritage Hospital in Tarboro, North Carolina.

Question: What is the pharmacist's role in the diabetes medical home and what is the cost impact?

Response: In our program, our pharm D will contact the case manager directly if it looks like our clients are overusing a certain medication, especially when it comes to their diabetes. They will contact us if it looks like they’re taking too much insulin and if they’re having complications. We have to contact their doctor and find out what they were given. The cost of the pharmacy goes up when you first start working with a client who has not been controlled. It goes up because they’re going to become more compliant. As they become complication-free, their hemoglobin, their lipid panel and their medication all start to decrease. They will be on a steady medication and will not get more prescriptions from different doctors. In the beginning it’s going to be higher, and then toward the end it will come down.

For more information on diabetes care and case management, please visit:

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Penalties for HRA Refusals

Aggregate data from health risk assessments (HRAs) provide a snapshot of population health status that guides healthcare payors, purchasers and providers in the design of health improvement or DM initiatives. We wanted to find out how many healthcare organizations penalize individuals who do not take an HRA.

Click here to view the chart.

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2011 Benchmarks in Healthcare Case Management

Not only are more organizations utilizing healthcare case managers, but the practice of embedding case managers at the point of care is becoming de rigueur, according to the second annual Healthcare Case Management e-survey conducted by the Healthcare Intelligence Network. This white paper documents the details of contemporary case management and the evolving responsibilities of today’s case manager from the 201 healthcare organizations that responded to HIN's January 2011 survey.

To download this complimentary white paper, please visit:

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3 Ways to Reduce Prevention Gaps Among Elderly, Diverse Populations

Critical gaps exist between older Americans who receive potentially lifesaving preventive services and those who do not, according to a new CDC report, which highlights the need to promote preventive services for adults age 65 and older, especially among minorities. The report features innovative strategies applied at the local, state and national levels to increase the use of preventive services in underserved communities, which include: promotion of policies to increase community access, making services available in convenient community settings, such as providing influenza vaccinations at polling places on election days; and building awareness through media.

Clinical prevention services examined in the report include vaccinations that protect against influenza and pneumococcal disease (e.g., bloodstream infections, meningitis and pneumonia), screenings for the early detection of breast cancer, colorectal cancer, diabetes, lipid disorders and osteoporosis, and smoking cessation counseling. Contributors to and supporters of this report agree that the use of preventive services should be a high priority of community and health systems alike. While the benefit of expanded insurance coverage is substantial, it is also important that older adults take advantage of preventive services on a regular basis to ensure good health.

The report also addresses the use of preventive services by diverse populations. Forty-nine percent of Asian/Pacific Islanders and 47 percent of Hispanics reported not being screened for colorectal cancer, in comparison to 34 percent of Caucasians. More than 50 percent of Hispanics, 47 percent of blacks and Asian/Pacific Islanders, and 36 percent of Caucasians report never receiving a pneumococcal vaccination. According to the report, challenges underlying these disparities are complex and reach beyond the traditional healthcare arena of patient-provider interactions. Older adults may not be aware of the services recommended for their age group or may not know that the services are covered by Medicare.

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. Join the more than 65 healthcare companies that have shared their 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.

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

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