Disease Management Update
Volume IV, No. 51
April 17, 2008

Dear Healthcare Intelligence Network Client,

In any relationship, communication is key, and this is certainly true of relationships within the healthcare arena. This week's Disease Management Update examines how communication between patients and proviers can decrease disparities in care and another study that suggests more doctor-patient communication can actually lower a patient's risk of heart disease.

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

If this is a forwarded copy of Disease Management Update and you like what you see, you can register to receive your own copy of this complimentary service. Sign up at:

Table of Contents

  1. Lack of Patient-Provider Discussion Contributes to Disparities in Use of Breast Reconstruction after Mastectomy
  2. Disease Management Q&A: Managing Communications in the Medical Home
  3. HealthSounds Podcast: Improving Communications
  4. Communication is Key to a Healthy Heart
  5. Survey of the Month: Personal Health Records for Consumers
  6. Online Healthcare: Benchmarks for Assessing Effectiveness, Trust, Outcomes and Perceptions of Cost

1. Lack of Patient-Provider Discussion Contributes to Disparities in Use of Breast Reconstruction after Mastectomy

Researchers at Brigham and Women’s Hospital (BWH) and Dana-Farber Cancer Institute (DFCI) concluded that lack of patient-provider discussion may contribute to socioeconomic, age and race-related inconsistencies in the use of breast reconstruction after mastectomy. However, the study also found that reconstruction was more likely to occur after the surgeon discussed options with the patient, suggesting that efforts are required to increase and improve these conversations.

“We learned that physicians need to improve communications with patients and whenever possible, universally address the issue of reconstruction with all women undergoing a mastectomy, regardless of age, race or socioeconomic status," said Caprice C. Greenberg, M.D., instructor of surgery in the Center for Surgery and Public Health at BWH and the Center for Outcomes and Policy Research at DFCI.

To learn more about this study, please visit:

2. Disease Management Q&A: Managing Communications in the Medical Home

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's experts are Dawn Bazarko, senior vice president of clinical innovations for UnitedHealthcare, and Dr. Lonnie Fuller, medical director for the Pennsylvania Medicaid ACCESS Plus PCCM-DM Program.

Question: How do you manage communication among all providers caring for a patient in a medical home?

Response: (Dawn Bazarko) This is a challenge, particularly if the system of care is not connected electronically. There are certainly some exceptions to that, where you have large integrated delivery systems with common EMRs that are shared and used to track tests and referrals between hospitals, ERs and ambulatory settings. There’s not a “one size fits all” approach to make this happen. Practices need to work with the tools they have and augment with other capabilities that are proven successful. As a company, we’ll be enabling some of this by proactively creating communication contacts. For example, with high volume specialists and rules such as, “When I refer to you, I’d like a report back on the disposition of the patient within X amount of time,” we set an expectation of closing that loop, which can essentially be paper-based. This is just one example of many possibilities. I’m not advocating for more paper. However, in lieu of everyone wired together, which is not a reality today, we must work with what we have and build upon that. Effectively managing care transitions and avoiding defects and duplicative testing and resource use is a challenge, as well as an important opportunity for the medical home approach. We’re excited to test these new methods in the medical home, and enable these connections through technology where we can use best practices.

(Dr. Lonnie Fuller) I would like to address this from inside the primary care practice. There are a number of different people doing different things with the patients. There are nurses taking their vital signs or providing education. In the charts — whether they’re electronic or paper — you’ll need a system, usually through a flow sheet, that allows you to communicate with one another. For example, if there is a licensed practical nurse (LPN) who goes into the exam room and performs the colon cancer screening education and fills out the paperwork for that patient to get a colonoscopy, you need a place on the chart to document that. That way, the physician can go in and say, “Mrs. Jones, I see you’re going to get your colonoscopy.” If the physician doesn’t know that, she might take the time to do the healthcare education also. Often, we’ve set up teams that consist of the front desk, back office, nurses, providers and doctors are the mid-levels so we can ensure we’re all on the same page with how we’ll take care of a group of patients. Sometimes practices will have a huddle first thing in the morning. They’ll look over the charts and say, “Here’s Mrs. Thompson. She’s going to need X, Y and Z.” That way, they’re on the same page so that when she arrives, they can move in a coordinated fashion.

For more payor-provider perspectives on establishing a medical home model, please visit:

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

3. HealthSounds Podcast: Improving Communications

In this week's disease management podcast, Gregg Lehman, currently president and CEO of HealthFitness, but president and CEO of Inspiris at the time of this podcast, explains how miscommunication during the care transition puts elderly patients at risk for reduced quality of care, poorer outcomes and unnecessary procedures. He defines the key players on the care transition team, suggests strategies for improving communications during this crucial phase and describes his organization's approach to dual eligibles who find themselves at this healthcare crossroad.

To listen to this complimentary HIN podcast, please visit:

4. Communication is Key to a Healthy Heart

Researchers at Temple’s Telemedicine Research Center finished a four-year study that examined the prevention of heart disease in at-risk, but otherwise healthy patients in rural and urban settings through frequent patient-doctor communications. The patients and doctors interacted via an Internet-based health reporting system in conjunction with regular clinic visits.

Researchers found that adding the Internet reporting system to traditional office visits allowed participants to communicate more frequently with their healthcare providers, and as a result, they were able to lower their risk of heart disease by improving blood pressure, blood lipid levels and cardiovascular disease risk score.

To find out more about this research, please visit:

5. Survey of the Month: Personal Health Records for Consumers

Complete our online survey on personal health records for consumers by April 30, and you'll get a free executive summary of the compiled results.

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

6. Online Healthcare: Benchmarks for Assessing Effectiveness, Trust, Outcomes and Perceptions of Cost

According to a recent Wall Street Journal article, only 19 percent of employees who were able to choose their healthcare plan chose a consumer-directed plan. Those already enrolled in such a plan often report low satisfaction and confusion about how the plan works. Companies offering these plans can do a better job at communicating what health savings accounts (HSAs) and High Deductible Health Plans (HDHPs) are, how they work and why the consumer should be enrolled in one. The Web offers the potential for companies to provide this information and get consumers started easily and quickly.

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