Disease Management Update
Volume V, No. 47
April 9, 2009
Dear Healthcare Intelligence Network Client,
Prevention, while just as important as treatment, is too often overlooked by providers and patients when it comes to managing their health. This week's Disease Management Update showcases a new device that may help predict cardiac events and the effect stress management can have on some cancer patients.
Thanks to all of our readers who took the time to participate in the Disease Management Update Readership Survey. Your responses are extremely valuable to us and will be used to shape future issues of this newsletter. The winner of the free copy of our newest DM resource, "Comorbidity Care Models: Integrated Action Plans for Complex Healthcare Needs," is Donna Riedle at Spectrum Health Systems. Congratulations!
Your colleague in the business of healthcare,
Editor, Disease Management Update
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Table of Contents
1. Simple Finger Device May Help Predict Future Heart Events
Results of a Mayo Clinic study show that a simple, noninvasive finger sensor test is "highly predictive" of a major cardiac event, such as a heart attack or stroke, for people who are considered at low or moderate risk. The noninvasive finger test device, called the EndoPAT by Itamar Medical, measures the health of endothelial cells by measuring blood flow. Endothelial cells line the blood vessels and regulate normal blood flow. Research has shown that if the cells don't function properly — a condition called endothelial dysfunction — it can lead to hardening of the arteries and major cardiovascular health problems.
Forty-nine percent of patients whose EndoPAT test indicated poor endothelial function had a cardiac event during the seven-year study. Researchers at Mayo Clinic and Tufts-New England Medical Center in Boston used the device to test 270 patients between the ages of 42 and 66 and followed their progress from August 1999 to August 2007. These patients already knew that they had low-to-medium risk of experiencing a major heart event, based on their Framingham Risk Score. The score is the commonly used risk predictor and was developed from the Framingham Heart Study, a longitudinal study of heart disease.
Some of their risk factors included high blood pressure, high cholesterol, obesity and a family history of heart disease. "The results of the study may help identify a discriminating tool beyond the Framingham Risk Score," said Amir Lerman, M.D., a cardiologist at Mayo Clinic and the senior author of the study. "And the results of these individual tests may help physicians change a patient's medications or recommend other therapies, so they don't have a heart attack or stroke later on," said Dr. Lerman. The test may be used in an individualized medicine model of risk assessment of the patients.
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2. Disease Management Q&A: Prevention vs. Management
Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Gregg Lehman, CEO of HealthFitness, and former president and CEO of Gordian Health Solutions.
Question: What is the biggest challenge physicians who want to emphasize disease prevention over disease management face?
Response: (Gregg Lehman) Changing lifestyle behavior is not easy. Many times patients get advice from their physicians, walk out the door and throw the prescription in the wastebasket. Generally, Americans seek treatment from physicians when they have symptoms. While some go to physicians for checkups, they really don’t pay physicians to keep us well. Often patients do not comply with the lifestyle and health management advice that their physicians give them. Physicians on the other hand find themselves frustrated by patients who do not heed their advice and are often at a loss to understand or even accept the responsibility they have to change their patient’s behavior. This is a real conflict. In fact, a lot of these disease states are modifiable — or at least their risk factors are.
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3. HealthSounds Podcast: Cost Savings from Prevention
Financially stressed healthcare organizations seeking alternative revenue streams should study wasteful medical practice variations that consume an estimated 30 percent of every healthcare dollar, advises Dr. David Chin, a national partner in the Health Industries Advisory Practice of PricewaterhouseCoopers LLP and the managing partner of PwC’s Global Healthcare Research Institute. Focusing on emerging trends, Dr. Chin reflects on the growing multinational focus on wellness and prevention as a cost-saving measure and the impact that new models of primary care will have on related occupations.
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4. Pre-Surgical Stress Management Improves Mood, Quality of Life for Prostate Cancer Patients
Brief stress management sessions prior to and immediately after surgery may have both short- and long-term benefit for men undergoing a radical prostatectomy for early-stage prostate cancer, according to research from the University of Texas M. D. Anderson Cancer Center. The study is the first to examine the benefits of psychosocial intervention for prostate cancer patients prior to surgery. It found that men who participated in the sessions experienced less short-term mood disturbance and better long-term quality of life, compared to patients who had the procedure but did not have any behavioral intervention.
Most psychosocial interventions in cancer of any type have been studied after patients have completed surgery, explained Lorenzo Cohen, Ph.D., the study’s senior author and professor in M. D. Anderson’s departments of behavioral science and general oncology.
"Before we can suggest that stress management is useful prior to surgery for all men undergoing a radical prostatectomy, we need to better understand the mechanism behind our findings, as well as understand for whom this type of intervention will be the most useful," Dr. Cohen said. "However, that said, all diagnosed with cancer treatment should be encouraged to participate in any stress management program — be it mind-body, or cognitive in nature. We know that they are safe and may improve patients' well-being and help them adjust to a cancer diagnosis."
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5. Survey of the Month: Managing Care Transitions Across Sites
Planning a patient's care transitions and closing the gaps in care from one healthcare setting to another can have a significant effect on health outcomes, likelihood of readmission and ER visits, cost to patients, providers and insurers, and the burden on caregivers and family members. Please share your organization's experiences with care transitions by completing HIN's Survey of the Month. You'll receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.
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6. Baby Boomers’ Impact on Healthcare: High Demands, Expectations Met with a Healthy Dose of Prevention
Baby boomers have practically achieved cult status. As the first of the post-World War II generation enters their 60's, the media has been recounting their preferences in everything from music to parenting to lifestyles. Boomers are depicted as an educated, financially secure bunch, redefining retirement as they care for aging parents and launch second careers. Job-wise, they’re having the last laugh: Employers who shunned the older worker 20 years ago now recast work schedules and job descriptions to woo boomers back to work. But the picture wouldn’t be complete without some sobering statistics, particularly when it comes to the healthcare needs of boomers.
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