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July 2, 2009 Volume VI, No. 7

HIN Communications Editor Laura Greene

Dear Healthcare Intelligence Network Client,

The American Diabetes Association reports that nearly 24 million people in the United States have diabetes. Given this statistic, it's no wonder this condition puts such a huge burden on the U.S. healthcare system. This week's DM Update looks at diabetes as it relates to the economy and the increased risks patients with diabetes face.

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

This week's DM news:

Table of Contents

  1. Diabetes and the Economy
  2. Diabetes Patients Face More Risks
  3. Diabetes Medical Home
  4. Case Manager Role
  5. Healthcare Trends & Studies
  6. Elderly Falls
  7. Health Coaching in '09

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Diabetes is a Significant Economic Burden for U.S. Healthcare System

Excess medical expenses and reduced productivity due to diabetes costs the U.S. economy more than $174 billion annually, a figure that could be reduced by lifestyle modifications and preventive care and by PFP incentives that reward improved DM.

Three articles in Population Health Management examine the challenges presented by the rising number of Americans with diabetes. The reports estimate the national medical costs associated with caring for adults with prediabetes or gestational diabetes and present a critical analysis of a PFP incentive to improve the care of patients with diabetes. One article showed that in 2007, care for these patients was more than $25 billion, or an additional $443 for each adult compared to individuals with normal blood sugar levels. Gestational diabetes mellitus in the United States in 2007 cost an additional $3,305 per pregnancy, plus $209 during an infant's first year of life. In 2007, for the estimated 180,000 pregnancies affected by gestational diabetes, the total national medical costs were $636 million.

To reduce these costs, excessive use of medical services by adults with diabetes could be reduced by better adherence by physicians to evidence-based clinical guidelines intended to improve diabetes care. Adult PCPs should encourage consistent adherence to guidelines and perform a critical review of practice patterns related to care of diabetic patients.

To learn more about this research, please visit:

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Hypoglycemia Increases Mortality Risk, Lengthens Hospital Stay for Diabetes Patients

Diabetes patients who are hospitalized for non-critical illnesses and develop hypoglycemia while hospitalized are likely to remain hospitalized longer and face greater risk of mortality both during and after hospitalization, according to researchers at Brigham and Women's Hospital. This retrospective cohort study of more than 4,300 admissions was the first to examine mortality risks for hospitalized diabetes patients outside a critical care setting. Previous research found an association between hypoglycemia in ICU patients and an increased risk of morality, seizures and coma.

However, the majority of hospitalized diabetes patients are treated on the general ward. This study found that each hospital day in which a person with diabetes had at least one episode of hypoglycemia was associated with an 85.3 percent increased risk of dying as an inpatient and a 65.8 percent increased risk of dying within one year of discharge. The odds of inpatient death also tripled for every 10 mg/dl decrease in the lowest blood glucose during hospitalization. A patient's length of stay increased by 2.5 days for each day spent in the hospital with a hypoglycemia episode.

As a result of these findings, the researchers recommend carefully monitoring people with diabetes admitted to the general ward of the hospital for hypoglycemia and suggest interpreting its appearance as "a warning sign of impending clinical deterioration."

To learn more about this research, please visit:

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Building a Diabetes Medical Home

In another validation of the benefits of the patient-centered medical home model, a unique data exchange between the largest insurer in New Jersey and an 850-physician organization resulted in a member-specific profile for each diabetes patient accessible at the point of care. Partners in Care Medical Director Dr. James Barr describes the fine points of the one-year pilot that joined the disease management efforts of Horizon Blue Cross Blue Shield of New Jersey with those of Partners in Care physicians to dramatically improve compliance levels and clinical outcomes for patients with diabetes.

To listen to this complimentary HIN podcast, please visit:

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The Role of the Case Manager

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Roberta Burgess, R.N., nurse case manager, Community Care Plan of Eastern Carolina with Heritage Hospital in Tarboro, North Carolina.

Question: What is the role of case managers in this program and how do their efforts translate into healthcare savings?

Response: Case managers work with the providers in the practice, and when our clients go to appointments sometimes we’re there to meet them or transport them. Our role is to help facilitate communication between the client and the physician. We also do home visits with our clients in the community, provide education and motivation and talk to high risk diabetics, new diabetics and high-cost diabetics. Last year alone we saved $230 million in North Carolina.

For more information on diabetes and the medical home, please visit:

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Better Health Outcomes for Chronically-Ill and High-Cost Patients

McKesson Corporation and CMS Health Integrated are providing CoverColorado with the nation’s first integrated care program for high-risk health plan participants. More than 3,000 people with chronic and high-cost health conditions now have access to an around-the-clock, integrated care program that includes both disease management and case management services.

To download this complimentary white paper, please visit:

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Older Adults Treated in ED for Fall Injuries Related to Walkers and Canes

From 2001 to 2006, an average of 129 Americans ages 65 and older were treated in the ED each day --- a total of more than 47,000 each year --- for injuries from falls that involved walkers and canes, according to a CDC study. The study, which examined six years of ED medical records, found that, for older adults that had falls related to walkers or canes, most of the injuries involved walkers (87 percent). People were seven times more likely to be injured in a fall with a walker as with a cane. Older women sustained more than three out of four walker-related injuries (78 percent) and two out of three cane-related injuries (66 percent).

“Walking aids are very important in helping many older adults maintain their mobility. However, it's important to make sure people use these devices safely,” said Judy Stevens, Ph.D., the study's lead author. “Walkers are often used by frail and vulnerable older adults; people for whom falls, if they occur, can have very serious health consequences.”

The study shows that doctors should take more time to better fit patients with walking aids and to teach patients how to use them safely. Falls are the leading cause of nonfatal injury in the United States, and falls among older adults can have especially serious consequences. To help reduce the risk of falling, CDC's Injury Center recommends that adults ages 65 and older begin a regular exercise program, have their doctors review their medications, have their vision checked, and make their home surroundings safer.

To learn more about this research, please visit:

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Health Coaching Trends in 2009

The health coaching field is evolving, as it is becoming more widely accepted as a means of helping patients better manage their health conditions. HIN's Survey of the Month revisits this field to find out how and to what extent healthcare organizations are implementing health coaching into their organizations. Complete HIN's Survey of the Month on Health Coaching Trends in 2009 by July 31 and receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

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

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