Disease Management Update
Volume IV, No. 47
March 20, 2008

Dear Healthcare Intelligence Network Client,

According to the Journal of the American Medical Association (JAMA), cardiac arrest experienced outside a hospital setting is becoming a major health concern and chances of survival are slim for the more than 250,000 Americans who experience it each year. This week's update features new out-of-hospital treatment that is increasing cardiac arrest survival, as well as a study from Brigham and Women's Hospital on predicting one's risk of cardiovascular disease (CVD).

Visit HIN's blog to read about children and heart health.

Your colleague in the business of healthcare,
Laura M. Greene
Editor, Disease Management Update

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Table of Contents

  1. Simple Non-Lab Methods as Good as Lab Tests at Predicting CDV
  2. Disease Management Q&A: How-to's of Home Visits
  3. HealthSounds Podcast: Pursuing Perfect Care
  4. Emergency Treatment for Out-of-hospital Cardiac Arrest Significantly Improves Survival Rates
  5. Survey of the Month: Pain Management in Healthcare and the Workplace
  6. Better Health Outcomes Through Disease Management

1. Simple Non-Lab Methods as Good as Lab Tests at Predicting CDV

A new study from Brigham and Womenís Hospital (BWH) shows that methods using non-laboratory-based risk factors predict cardiovascular events as accurately as more costly laboratory-based tests.

Of 14,407 participants, researchers found that in the 6186 people initially not reporting a history of CVD, there were 1529 first-time cardiovascular events and 578 deaths due to CDV over a 21-year period. Both lab and non-lab methods calculated a number called the c-statistic to assess cardiovascular risk prediction, and for both men and women, lab and non-lab methods gave similar c-statistics. Furthermore, the non-lab method correctly classified patients at the same rate as the lab method across four commonly used levels of risk used in guidelines around the world, suggesting good calibration.

Study authors add that the cost for developing nations to perform cholesterol tests on patients who were at risk for the development of CVD could use more than 10 percent of the nationís healthcare budget, which adds little benefit to non-lab tests. Non-labs test are effective at collecting the appropriate information to determine risk quickly and in a non-invasive way.

To learn more about this study, please visit:

2. Disease Management Q&A: How-to's of Home Visits

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Michele Gilbert, education coordinator of the heart failure team at Hackensack University Medical Center (HUMC).

Question: What are the components and goals of the home visits conducted by the heart failure team?

Response: (Michele Gilbert) We have spent a lot of time teaching our home care nurses to be astute observers. One thing the nurse will do is interview the patient regarding their health practices and understanding of the disease. We give patients basic educational information. When the nurse conducts the visit, she does a complete physical assessment, as well as an assessment of the patientís functional abilities. We use the Minnesota Living With Heart Failure Questionnaire, which addresses functional status for the patient. We use that at the first and last visits to ensure that the patientís functional status and ability to self-manage is improving. We find out what the patient has been eating and what theyíre doing. We get our baseline.

On subsequent visits, the nurse might empty the patientís pantry and show them how much sodium theyíve been eating. They ensure the patient understands where to find hidden sources of sodium. The nurse continues to assess the patientís progress. They will provide them with a daily system for weighing themselves and recording their weight. The patientís ability to self-medicate is also assessed. If they donít have a system for taking their medications, we provide one, such as a seven-day pillbox with four compartments.

For more information on successful management of heart failure patients, please visit:

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

3. HealthSounds Podcast: Pursuing Perfect Care

In this week's disease management podcast, collaborative patient care models that empower the primary care nurse to communicate patient needs to physicians have not only improved patient care and outcomes but also fostered a cultural change at Hackensack University Medical Center, explains Lenore Blank, a nurse practitioner and administrative manager of HUMC's heart failure and pulmonary hypertension team. Her team is part of Pursuing Perfection, a healthcare quality initiative from the Institute of Healthcare Improvement. As HUMC creates the partnerships mandated by Pursuing Perfection, it is extending the knowledge and benefits they've gained with other organizations — and reducing hospital readmissions in the process.

Additionally, Leanne Huminski, chief nursing officer, McLeod Regional Medical Center, comments on capitalizing on computer technology, McLeod's initiatives for eliminating adverse drug events (ADEs) and the role information technology is playing in reducing ADEs.

Physician and executive engagement are one of the crucial success factors for clinical improvement, says Donna Isgett, vice president for clinical effectiveness at McLeod Health. Isgett describes a simple design process that McLeod uses to guide its clinical improvement principles.

To listen to this complimentary HIN podcast, please visit:

4. Emergency Treatment for Out-of-hospital Cardiac Arrest Significantly Improves Survival Rates

According to a study published in the Journal of the American Medical Association (JAMA), cardiac arrest experienced outside a hospital setting is now a major public health concern, and survival is uncommon. In 2004, an estimated 97 percent of people suffering cardiac arrest in Arizona did not survive. The study examined a new life saving procedure taught to emergency medical services (EMS) providers. The procedure is called Minimally Interrupted Cardiac Resuscitation, also known as Cardiocerebral Resuscitation (CCR), and is not only easy to train and administer, but significantly more likely to save lives.

The JAMA paper reports the results of EMS providers trained in CCR, compared with those receiving standard advanced life support in Arizona. The survival-to-hospital discharge rate tripled, from 1.8 percent in the control group, to 5.4 percent in the CCR-trained group. Further, in a subgroup of patients with ventricular fibrillation where chances of success are highest, the survival rate increased from 4.7 percent to 17.6 percent.

The advantage of CCR over traditional CPR is that it better maintains steady blood flow to the heart and brain during resuscitation. This is important to survival, as well as obtaining a favorable neurological outcome. It also minimizes the danger of over-ventilation, which increases intra-thoracic pressure in the chest that can endanger critical blood flow back to the heart.

To see more about this study's results, please visit:

5. Survey of the Month: Pain Management in Healthcare and the Workplace

Complete our online survey on pain management in healthcare and the workplace by March 31, and you'll get a free executive summary of the compiled results.

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

6. Better Health Outcomes Through Disease Management

McKesson Corporation and CMS Health Integrated are providing CoverColorado with the nationís first integrated care program for high-risk health plan participants. More than 3,000 people with chronic and high-cost health conditions now have access to an around-the-clock, integrated care program that includes both disease management and case management services.

To download this complimentary white paper, please visit:
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