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May 28, 2009 Volume VI, No. 2

HIN Communications Editor Laura Greene

Dear Healthcare Intelligence Network Client,

To vaccinate or not to vaccinate? That is the question that many parents are asking their physicians and themselves in regards to their children's health. While there is some thought that certain vaccinations can lead to even more serious health conditions like autism, new research shows children who are not vaccinated are at an increased risk for conditions that many believe have all but disappeared in the United States.

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

This week's DM news:

Table of Contents

  1. PCPs Miss Diagnosis
  2. Effects of Smallpox
  3. Engaged Consumers
  4. Care Improvement
  5. Healthcare Trends
  6. Whooping Cough
  7. Uninsured & Underinsured

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PCPs Miss Whooping Cough Diagnosis in Teens

Doctors can do a better job of diagnosing whooping cough among teens, an age group with a growing incidence of the illness, according to a University of Michigan (U-M) study. In a national study of PCPs, U-M researchers found that nearly one out of seven physicians were not able to recognize whooping cough in a standardized adolescent case patient. A similar proportion did not test adolescents for whooping cough as part of their routine clinical practice, says Amanda Dempsey, M.D., Ph.D., MPH, assistant professor of pediatrics and communicable diseases at the U-M Medical School and the study’s lead author.

Whooping cough is a common infection that leads to significant morbidity and sometimes death. Because adolescents are considered to be a primary infection-spreading group, researchers say it is imperative to recognize and diagnose it in a timely and accurate manner. The study showed there is a need to increase provider education about the importance of recognizing whooping cough in order to minimize outbreaks.

Results of the national survey of 702 general pediatricians and family medicine physicians suggest that testing, recognition of clinical symptoms and case management of whooping cough in adolescents among PCPs is suboptimal. A majority of physicians surveyed, 86 percent, said they experienced at least one barrier to testing. These barriers included the delay in obtaining test results, having to send the patient to an outside facility to collect a sample, inaccurate diagnostic tests and lack of testing supply availability. A substantial proportion of physicians surveyed identified lack of familiarity with testing protocols as a major barrier to testing. Many said they did not recognize the clinical symptoms of whooping cough in a case patient. The study showed that doctors more familiar with the disease were more likely to manage the case patient appropriately. Overall results of this study suggest that more efforts are needed to improve doctors’ knowledge about the symptoms of and diagnostic procedures for identifying whooping cough.

To learn more about this research, please visit:

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Smallpox May Derail Human Immune System

University of Florida (UF) researchers have learned more about how smallpox conducts its deadly business — discoveries that may reveal as much about the human immune system as they do about one of the world’s most feared pathogens. In findings to be published in the Proceedings of the National Academy of Sciences, scientists describe how they looked at all of the proteins produced by the smallpox virus in concert with human proteins, and discovered one particular interaction that disables one of the body’s first responders to injury — inflammation.

With researchers from the University of Alberta, the CDC and a private company called Myriad Genetics, UF researchers for the first time systematically screened the smallpox proteome — the entire complement of new proteins produced by the virus — during interactions with proteins from human DNA. These protein-on-protein interactions resulted in a particularly devastating pairing between the viral protein G1R and the human protein human nuclear factor kappa-B1, which is believed to play a role in the growth and survival of both healthy cells and cancer cells by activating genes involved in immune responses and inflammation.

“One of the strategies of the virus is to inhibit inflammation pathways, and this interaction is an inhibitor of human inflammation such that we have never seen before,” said Grant McFadden, a professor of molecular genetics and microbiology at the College of Medicine and a member of the UF Genetics Institute. “This helps explain some of the mechanisms that contribute to smallpox pathogenesis. But another side of this is that inflammation can sometimes be harmful or deadly to people, and we may learn a way to inhibit more dangerous inflammation from this virus.”

Smallpox is blamed for an estimated 300 million deaths in the 20th century alone, and outbreaks have occurred almost continuously for thousands of years. The disease was eradicated by a worldwide vaccination campaign, and the last case of smallpox in the United States was in 1949, according to the CDC. The last naturally occurring case in the world was in Somalia in 1977. With the exception of stores of the virus held in high-containment facilities in the United States and Russia, smallpox no longer exists on the planet. Since it was no longer necessary for prevention, and because the vaccines themselves were risky, routine vaccination against smallpox was stopped. However, public health concerns regarding the possible re-emergence of the virus through bioterrorism have led to renewed interest in the development of treatments for the disease and safer vaccines.

To learn more about this research, please visit:

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Assessing the Engaged Healthcare Consumer for Self-Efficacy

There are many ways to administer the Patient Activation MeasureTM and many socioeconomic factors that influence its outcomes, explains Dr. Judith Hibbard, developer of the PAM and professor of health policy at the University of Oregon. Dr. Hibbard identifies the PAM scores that signal a behavior change and the value of adding patient activation assessment to a health improvement initiative.

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Measuring Impact of Care Improvement

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Dr. Chad Boult, professor of public health, medicine & nursing and director of the Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health.

Question: What is the best way to measure the impact of comorbidity reduction in DM?

Response: It’s important to point out that these people have chronic diseases, and very few of them are ever cured. We’re not likely to reduce people’s morbidity itself. We can’t cure these diseases, but we certainly can improve the quality of the care they get. You can measure that by HEDIS or the Patient Assessment of Chronic Illness Care (PACIC) instrument that we use. You can improve some of the outcomes of care, like quality of life for the patients and cost for the insurer.

For more details on comorbidity care models, please visit:

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Baby Boomers’ Impact on Healthcare

Baby boomers have practically achieved cult status, redefining retirement as they care for aging parents and launch second careers. 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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Refusing Immunizations Puts Children at Increased Risk

Children of parents who refuse vaccines are 23 times more likely to get whooping cough compared to fully immunized children, according to a new study led by a vaccine research team at Kaiser Permanente Colorado’s Institute for Health Research. This is the first study to use EHRs to look for immunization refusal and possible pertussis infections, making it the most definitive on the risk of vaccine refusal to date.

While most families vaccinate their children, leading to dramatic reductions in several serious childhood illnesses, the number of parents refusing immunizations appears to be increasing in the United States, researchers say. The study findings are important for parents who cite low risk of infection as a reason to choose fewer or no immunizations, and for researchers who are concerned that decreased immunization rates could lead to more disease outbreaks across the country.

“This study helps dispel one of the commonly held beliefs among vaccine-refusing parents: that their children are not at risk for vaccine-preventable diseases,” said study lead author Jason Glanz, Ph.D., a senior scientist at Kaiser Permanente’s Institute for Health Research. “It also shows that the decision to refuse immunizations could have important ramifications for the health of the entire community. Based on our analysis, we found that one in 10 additional whooping cough infections could have been prevented by immunization. As a father of young children, I understand that vaccines can pose confusing and difficult choices, so the purpose of this research is to give parents more information to weigh the benefits and risks, and to provide pediatricians with more information to help participate in the discussion,” Dr. Glanz said.

To learn more about this research, please visit:

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Uninsured & Underinsured

So far, more than 75 healthcare organizations have answered this month's e-survey on healthcare's response to the growing numbers of uninsured and underinsured, from strategies to reduce the financial impact of these populations to ways to make healthcare more accessible and affordable for them. There's still time to 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.

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