Disease Management Update
Volume V, No. 9
June 26, 2008

Dear Healthcare Intelligence Network Client,

Eating habits, exercising, smoking — all things that can affect one's health. But there are some factors that are out of an individual's control. This week's Disease Management Update focuses on the socioeconomic factors — from education to income to marital status — that can impact health.

And, as gas prices are pinching our wallets more than ever, they are also pinching something else — our waists. Visit HIN's blog to find out how this economic factor is having a positive impact on obesity rates.

Your colleague in the business of healthcare,
Laura 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: http://www.hin.com/dmdesktop/diseasemanagement.html

Table of Contents

  1. Socioeconomic Factors Play a Part in Heart Attack Survival
  2. Disease Management Q&A: Teaching PCPs to Identify Postpartum Depression
  3. HealthSounds Podcast: Depression Disease Management
  4. Rural, Unmarried Women at Higher Risk for Depression
  5. Survey of the Month: Primary Care in 2008
  6. Depression and Disease Management Beyond the Stigma to Identification and Treatment

1. Socioeconomic Factors Play a Part in Heart Attack Survival

Researchers have long suspected that socioeconomic factors like education level and income might affect survival rates following heart attack. New data from the Mayo Clinic suggests that people with lower incomes and education levels are more likely to die after heart attack than more affluent, educated people.

Authors examined medical records from 705 patients residing in Olmsted County, Minn. who were treated for heart attack between Nov. 1, 2002 and May 31, 2006. Researchers recorded the years of schooling completed and neighborhood income for each participant. Participants were divided into three income groups and three education groups. Researchers analyzed survival data across these different groups.

Among the 155 deaths recorded during the study period, one-year survival estimates across income groups were lowest for people with the lowest income. Seventy-five percent were survivors among people earning $28,732 to $44,665; 83 percent survived among people earning $49,435 to $53,561; and 86 percent survived among people earning $56,992 to $74,034. Similarly, the survival rates were lowest for participants with less education. Sixty-seven percent were survivors among those who had fewer than 12 years of education; 81 percent survived among people with 12 years of education; and 85 percent survived among people with greater than 12 years of education.

“Gaining a reasonable amount of weight may be a sign patients are getting enough insulin and appropriately controlling their disease, which may partly explain why those who gained weight over time had lower mortality rates,” said Dr. Trevor Orchard, M.D., professor of epidemiology at the University of Pittsburgh Graduate School of Public Health.

To learn more about this study, please visit:

2. Disease Management Q&A: Teaching PCPs to Identify Postpartum Depression

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Christy L. Beaudin, PHD, LCSW, CPHQ, corporate director of quality improvement at PacifiCare Behavioral Health.

Question:How do you teach obstetricians (OBs), pediatricians and general practitioners to identify mothers at risk for postpartum depression (PPD) and make appropriate referrals?

Response: (Christy L. Beaudin) We take a multifaceted approach to provider education. We offer a physician consultation hotline available to any office staff. A staff member can call and speak with one of our doctors and/or licensed psychiatrists about proper treatment for any perceived maternity risk, above and beyond PPD.

A provider may believe a patient has PPD, but he may not be sure how to approach the subject or even what resources to offer. We bridge the gap. For many practices, this consultation service is necessary for an accurate assessment and effective care plan. We’re also integrating maternity staff within our health plans — participating in rounds, quarterly meetings and educational seminars. Sometimes all medical staff, including specialty providers, attends these group meetings. We’ve got professionals across the medical spectrum all in one room, and we give educational presentations that highlight common disorders and address their concerns.

Several health plans have expressed interest in maternity management because many of their members are women of childbearing age. It’s also important to work with affiliated case managers who have experience treating high-risk cases, including those presenting dual medical and behavioral health disorders. Treating PPD requires particularly strong communication efforts. In these cases, the OB may not even pick up on the problem. Patients may present maternity risk to their providers rather than their OBs, and the PCP may not have sufficient expertise in this area to act appropriately.

For more details on maternity disease management, please visit:

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

3. HealthSounds Podcast: Depression Disease Management

Dr. Sam Toney, president and chief medical officer of Health Integrated, describes how his organization's depression management program strives to include providers. Mary Beth Chalk, chief operating officer of Resources For Living, describes how her program helped a member deal with her chronic condition.

To listen to this complimentary HIN podcast, please visit:

4. Rural, Unmarried Women at Higher Risk for Depression

New research suggests that unmarried women living in rural areas have lower self-rated health status than their married counterparts. This lower health status often includes greater instances of self-assessed feelings of depression. The results of the study were recently published in the Journal of Evaluation in Clinical Practice. They suggest that PCPs should take a proactive role in addressing health concerns of single women.

Researchers used a cross-functional survey to gather self-ratings of overall health among female primary care patients aged 18 years and older who live in cities with a census of approximately 3,000. The study analyzed marital status and self-assessed mental health as potential risk factors for poor overall self-rated health among female primary care patients. The analysis revealed that single or divorced women are more prone to poor self-rated health compared to married women. Women who described themselves as being depressed also had worse overall health. Women aged 65 and older had an even higher risk of poor self-rated health.

To learn more about this study, please visit:

5. Survey of the Month: Primary Care in 2008

Many factors are affecting the primary care system in the United States — a predicted shortfall of PCPs, new models of care, unchanged models of reimbursement, a focus on quality initiatives and increased demands for healthcare IT. Join the more than 75 healthcare organizations that have completed our survey on primary care by June 30 and receive a free summary of the compiled results.

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

6. Depression and Disease Management Beyond the Stigma to Identification and Treatment

With the economic burden of depression and its comorbidities estimated at $83 billion annually — hitting employers hardest in the form of lost workdays, compromised productivity and workplace accidents — the healthcare industry is formalizing programs for early identification, adequate treatment and medical adherence of individuals with depressive disorder. This is no small task, given the challenges of screening depression severity, overcoming the stigma of mental illness and educating PCPs on the value of this initiative. In an e-survey, HIN asked its audience for details on initiatives for depression and disease management.

To download this complimentary white paper, please visit:
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