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May 7, 2009 Volume V, No. 51

HIN Communications Editor Laura Greene

Dear Healthcare Intelligence Network Client,

While 70 percent of smokers say they would like to quit, only 7.9 percent are able to quit smoking without help. A story in this week's DM Update discusses the impact physicians can have on their patient's cessation efforts by simply asking them about their tobacco use and connecting them with cessation services. Read on for more about this and for some smoking cessation incentives from an industry leader.

Your colleague in the business of healthcare,
Laura Greene, Editor

P.S. You might notice that this week's Disease Management Update looks a little different than usual. HIN reached out to its readers earlier this year to get their feedback on the DM Update. We have incorporated your comments and suggestions regarding both content and look of this newsletter. We'd love to hear your feedback on our new look at editors@hin.com Enjoy!

This week's industry news:

Table of Contents

  1. DM Dashboard: Smoking & EHRs
  2. HealthSounds: Health Risk Stratification Trends
  3. DM Q&A: Smoking Cessation Incentives
  4. Effects of Obesity, Arthritis on Quality of Life
  5. Healthcare Trends & Studies
  6. Ounce of Prevention: Asthma & Pregnancy
  7. Taking the Pulse of Healthcare: Uninsured & Underinsured

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1.) Smokers Get Help with the Use of Electronic Health Record

While the U.S. Public Health Service recommends that physicians ask all patients about their tobacco use and connect them to cessation services, there are still many patients who are never asked about their smoking habits. Researchers at Brigham and Women’s Hospital (BWH) have found that by enhancing the EHR, physicians were more likely to document a patient’s smoking habit and that access to cessation counseling was improved.

“As the use of the electronic health record expands, so does the opportunity to use it to improve patient care and delivery. In our study, we found that an enhancement in the electronic health record is a successful tool to remind clinicians to ask patients about smoking status and refer smokers for cessation counseling” said Jeffrey Linder, M.D., M.P.H., a physician and researcher at BWH and lead author of the study.

Dr. Linder and colleagues developed an EHR enhancement to increase documentation of smoking status, the prescription of tobacco treatment medications and referral of patients to tobacco treatment counseling. This study was performed in 26 primary care practices, which were randomized to be intervention practices and have the enhancement implemented in their EHR system or be a control practice without the enhanced EHR. Over a period of nine months, more than 315,000 patient visits were made to the participating practices.

Researchers found that documentation of a patient's smoking status in the EHR was improved in all participating practices, but intervention practices had a higher increase, a 17 percent increase compared to 11 percent in control practices. They also found that in practices with the intervention, patients who were documented smokers at the start of the study were more likely to be non-smokers at the end of the study (a 3.4 percent increase in documented non-smokers) when compared to practices without the enhancement in the EHR. Researchers note that this finding may be due to improved overall documentation. They also found the enhancement did not change the number of patients who were prescribed cessation medication, but did find that documented smokers at the intervention practices were over 10 times more likely to make contact with a smoking cessation counselor. Making contact with cessation counseling roughly doubles a smoker’s odds of successfully quitting.

To learn more about this research, please visit: http://www.brighamandwomens.org/Press...

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2.) HealthSounds: Health Risk Stratification Trends

Health claims are still scrutinized during risk stratification, but today's analysts examine these data points through a slightly different lens, explains John Harris, chief wellness officer and senior vice president for Healthways. Harris explains why the focus has shifted from ICD-9 coding patterns to the financial trends evident in the claims, and what accelerating or decelerating costs reveal about an individual's health status.

To listen to this complimentary HIN podcast, please visit: http://www.hin.com/podcasts/podcast.htm#86

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3.) DM Q&A: Smoking Cessation Incentives

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Ted R. Borgstadt, co-founder and CEO of TrestleTree, Inc.

Question: What impact can the absence of incentives have on tobacco cessation programs?

Response: (Ted Borgstadt) For any program that you roll out, if there's not some incentive to enroll, you're going to have very little participation. One organization started out with just tobacco cessation, and the incentive was a one-month supply of tobacco nicotine replacement patches. Rolling it out in a good communication package, participation was what you'd expect with a tobacco cessation program without a heavy incentive — that proverbial 3 percent of smokers joined the program.

For more details on the use of incentives in health improvement programs, please visit: http://store.hin.com/product.asp?itemid=3886

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4.) Women Live Longer, Not Better, Largely Because of Obesity and Arthritis

Obesity and arthritis that take root during early and middle age significantly contribute to women's decreased quality of life during their senior years, according to researchers at Duke University Medical Center. In a study that included 5,888 people over 65, women suffered up to two and a half times more disabilities than men of the same age. Higher rates of obesity and arthritis among these women explained up to 48 percent of the gender gap in disability — above all other common chronic health conditions.

"While women tend to live longer than men, this study shows that they are at greater risk of living with disability and much of the excess disability is attributable to higher rates of obesity and arthritis," said Heather Whitson, M.D., assistant professor of medicine and lead investigator of the study. "This is important because it suggests that women's tendency to pack on extra pounds in their child-bearing and peri-menopausal years translates into loss of independence in their old age."

The study is the first to isolate the impact of specific chronic health conditions on the difference in disability rates between older men and women. While many people are studying how chronic conditions affect mortality, the investigators were surprised to see the extent to which these conditions explained the gender difference in disability. The current study is an analysis of the Cardiovascular Health Study, which asked participants about their ability to conduct common activities of daily living, such as grooming, eating, getting dressed, managing money and upper and lower body movement, including reaching, grasping, walking and climbing stairs. The study also draws attention to two concerning health trends that could worsen the average quality of life for women in the future. First, as the rate of obesity continues to rise, the rates of disability in older adults are expected to increase. To the extent that women are more likely than men to develop obesity, the obesity epidemic will have its greatest impact on older women's quality of life. Second, the investigators note that women are gaining equality with men on cardiovascular disease, stroke and emphysema, which had previously been less common among women.

Rates of cardiovascular disease are not improving as quickly among women as they are among men and smoking-related disease is becoming more common in women. If the occurrence of these conditions becomes more comparable between men and women, the result would be an even wider gap in disability rates. In addition to obesity and arthritis, the study found the women were more likely than men to experience fractures, vision problems and bronchitis. Men were more likely to have emphysema, coronary heart disease, congestive heart failure, stroke, diabetes and hearing problems. Researchers say that the next step is to determine whether older women who have been disabled by obesity or arthritis regain function if they undergo treatment to help them achieve a healthy weight or to control their arthritis pain. If not, then it becomes even more important to focus efforts on preventing obesity and arthritis in younger populations.

To learn more about this research, please visit: http://www.dukehealth.org/HealthLibrary/News/...

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5.) Healthcare Trends & Studies

By funding an expansion of healthcare coverage for children with a 61-cent tobacco tax per cigarette pack, the U.S. government is doing their part in the crusade for tobacco cessation and prevention. Now, HIN examines how over 220 wellness companies, behavioral healthcare providers, PCPs, DM organizations, employers, health plans and hospital/health systems are contributing to the area of tobacco cessation and prevention.

To download this complimentary white paper, please visit:

Additional white papers: Nearly 300 healthcare professionals share how they are managing — and working to prevent — the growing problem of obesity.

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6.) Ounce of Prevention: Management of Asthma During Pregnancy/font>

Pregnant women with asthma, the most common condition affecting the lungs during pregnancy, should actively manage their asthma in order to optimize the health of mother and the baby, according to new management recommendations published in the current issue of the New England Journal of Medicine. The recommendations are based to a large degree on a 12-year Kaiser Permanente study of 1,900 pregnant women and a Maternal Fetal Medicine Units network study of 2,620 women from 16 university hospital centers around the country. Both studies concluded that women with actively managed asthma are just as likely to have healthy pregnancies and babies as women who don’t have asthma.

At any given time, 8 percent of pregnant women have asthma. During pregnancy, asthma worsens in about one-third of these women, improves in one-third and remains stable in one-third. Uncontrolled asthma can cause a decrease in the amount of oxygen in the mother's blood, which can lead to decreased oxygen in the fetal blood. Since a fetus requires a constant supply of oxygen for normal growth and development, this can lead to impaired fetal growth and survival. Women who are pregnant or planning to become pregnant should work with their doctors to develop a therapy plan, stay away from items that might trigger an allergic or asthmatic reaction, and never stop taking asthma medications without speaking to their doctor first. The report provides recommendations designed to help clinicians who care for pregnant asthmatic women, including asthma assessment, management of triggering factors, medication management, treatment of asthma attacks, obstetric management and patient education.

"Though studies suggest asthma during pregnancy can increase health risks for mom and baby, our research shows that women who manage their asthma can have as healthy a pregnancy as women who don't have asthma," said Michael Schatz, M.D., lead author of the NEJM recommendations and chief of the Allergy Department at Kaiser Permanente Medical Center in San Diego. “Many studies suggest that asthma can increase the risk of pregnancy complications, including preeclampsia, low birth-weight babies or preterm birth, however, women with well-controlled asthma in pregnancy generally have good pregnancy outcomes. Women who have asthma and are considering pregnancy should speak with their doctors to develop a therapy plan.”

To learn more about this research, please visit:

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7.) Taking the Pulse of Healthcare: Uninsured & Underinsured

The deepening national recession and growing number of uninsured nationally, estimated at around 52 million in January 2009, is taking its toll on the healthcare industry. Additionally, Commonwealth Fund data indicates that as of 2007, there were an estimated 25 million underinsured adults in the United States, up 60 percent from 2003. Please share the impact of the uninsured and underinsured on your organization by completing HIN's Survey of the Month. 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: http://www.surveymonkey.com/s.aspx...

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