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July 16, 2009 Volume VI, No. 9

HIN Communications Editor Laura Greene

Dear Healthcare Intelligence Network Client,

Some form of cardiovascular disease (CVD) — be it high blood pressure, coronary heart disease, stroke or heart failure — was responsible for one out of every 2.8 deaths in 2005. In fact, it claimed more lives than cancer and AIDS combined. This week's Disease Management Update shines some light on heart care in hospitals across the country as well as the potential problems dental diseases can cause.

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

This week's DM news:

Table of Contents

  1. Hospital Heart Care Varies Across Nation
  2. Oral Infections and CVD
  3. Uncompensated Care
  4. Sharing Knowledge
  5. Healthcare Trends & Studies
  6. Preventing Dementia
  7. Health Coaching in '09

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Hospital Heart Care Varies Across Nation

The 30-day death and readmission rates for acute care of heart attack and heart failure patients vary significantly from hospital to hospital across the nation, according to a new study published in Circulation: Cardiovascular Quality and Outcomes.

Researchers reviewed three years of experience (July 2005 to June 2008) of Medicare FFS patients with heart failure and heart attack. Calculating 30-day death and readmission rates, based on nearly 600,000 heart attack admissions and more than 1 million heart failure admissions at almost 5,000 hospitals nationwide, they found that the average 30-day death rate for heart attack was 16.6 percent and the average rate of heart attack readmission was 19.9 percent. The average 30-day death rate for heart failure was 11.1 percent and 24.4 percent for readmission. The researchers said their findings represent an opportunity for improvement.

"If we just look at readmission, one in four patients who has heart failure and one in five who has a heart attack is back in the hospital within 30 days for readmission," said Harlan M. Krumholz, M.D., the study's lead author and professor of medicine and outcomes researcher at Yale University School of Medicine in New Haven, Conn. "Variations in those rates from hospital to hospital tell yet another story. What we're seeing is that, for example, for heart attack patients, the best hospital in the country has a 30-day mortality rate of only about 11 percent and the hospital with the highest rate in the country has a rate of almost 25 percent."

Researchers also found that heart failure death rate ranged from 6.6 percent to 19.8 percent, readmission for heart attack ranged from 15.3 percent to 29.4 percent and readmission for heart failure ranged from 15.9 percent to 34.4 percent.

"This suggests that patients' outcomes are dependent, at least in part, on the hospital that provides their care," Dr. Krumholz said. "What we seem to have here are differences among hospitals that are based on quality and the systems that they have in place. If we could better understand how the best hospitals achieve their results and help the hospitals that are not doing as well improve, we could save many more lives."

To learn more about this research, please visit:

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Link Between Oral Infections and CVD Morbidity Explained

A strong connection between periodontal disease and CVD has been suggested in recent clinical studies. As many as 75 percent of adults in the United States have been affected by periodontal disease and an estimated 80.7 million adults — one out of three — have been a victim of CVD in 2006 according to the American Heart Association (AHA). From the 80.7 million adults in the United States, almost 50 percent are under 60 years of age. These findings strengthen their belief that oral infections contribute to CVD morbidity and connection of chronic infections and CVD, a topic of discussion at the Academy of General Dentistry's recent annual meeting.

The discussion integrated both dentistry and medicine because the disease is common to both health management groups. “It is critical for all dentists and physicians to collaborate in helping patients reduce inflammation, which can become a target factor for cardiovascular disease,” says Dr. Marvin J. Slepian, M.D.

CVD has a wide range of categories, which affect adults in the United States every day, including high blood pressure, coronary heart disease, stroke and heart failure. A recent study that was cited during the presentation explored the existence of bacteria known to cause periodontitis and the growth of blood vessel walls, which is a symptom of CVD. After examining the subjects used, the investigators found a positive connection between the growth of blood vessel walls and the existence of bacteria found in dental plaque, causing periodontitis.

To learn more about this research, please visit:

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Reducing Uncompensated Care Costs

Baptist's Health's referral of patients to its family medicine residency program has given residents a greater understanding of the fiscal impact of the uninsured on the healthcare system, and the benefits don't end there. Robin Barca discusses the residents' experience with the medical home model, details of patient contracts and just how much of Baptist's uncompensated care falls into charity care.

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Sharing Knowledge with Other Facilities

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Lenore Blank, administrative manager for Hackensack University Medical Center's dedicated inpatient heart failure unit.

Question: Can you provide some examples of partnerships that have resulted from your heart failure initiative?

Response: We reached out to subacute care facilities. We started with one in our catchment area to help them to better manage heart failure patients. We understood the importance of providing patients who go to these facilities with a two-gram sodium diet, daily weigh-ins, necessary patient education and the education that their nurses need to manage these patients. With patients admitted to rehabilitation facilities post-hospitalization for heart failure, there are generally high readmission and recidivism rates. We decided to partner with the subacute that wanted to work with us. We did some in-service programs for their nurses and administration. Then, we decided to visit there at least weekly to see the patients with the nurses, pull the nurse into the room, do a quick physical assessment and just be visible and work with them and try to get them to recognize signs and symptoms early so that these patients could be managed better and not bounced back into the hospital as frequently.

We did that for quite a few months, and then left them on their own while communicating telephonically. There were huge improvements in the care that these patients were getting and in the communication that we were getting from that subacute. For example, even when patients were not being weighed daily, just having them on that 2,000 milligram sodium diet and being able to maintain that low sodium diet made a difference with these patients. They didn’t run into trouble and have to be readmitted as frequently.

For more information on managing patients with heart failure, please visit:

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Underinsured & Uninsured: Taking a Toll on the Healthcare Industry

According to a 2007 study from the Commonwealth Fund, nearly 25 million Americans are underinsured and can’t close the gap between their insurance coverage and medical bills. At the beginning of 2009, the number of uninsured Americans was estimated at 52 million. This white paper is based on HIN’s May 2009 e-survey in which survey respondents were asked to share the impact of the uninsured and underinsured on their organizations.

To download this complimentary white paper, please visit:

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Preventing Dementia

The results of two trials into an omega 3 fatty acid, DHA (docosahexaenoic acid), as an Alzheimer’s Disease (AD) treatment, suggest the compound found in oily fish may only be effective at reducing dementia risk earlier in life, rather than for use as a treatment.

One 18-month trial of DHA in 400 elderly people with mild to moderate AD showed no evidence of DHA’s benefit in the study population. The second study was a six-month DHA trial that tested the effects of the compound in protecting against age-related cognitive decline. The results showed that DHA improved memory and learning, but was conducted in a population that did not have AD.

“These studies show that using omega 3 fatty acids as a treatment late on may not be effective against Alzheimer’s, but with previous population studies suggesting that fish oils could reduce dementia risk, getting oily fish, such as mackerel, herring, salmon and sardines into our weekly menus could still be good advice," said Dr. Simon Ridley, research manager for the Alzheimer’s Research Trust.

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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