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July 23, 2009 Volume VI, No. 10

HIN Communications Editor Laura Greene

Dear Healthcare Intelligence Network Client,

In 2008, the CDC put the amount of U.S. adults age 18 years and over who smoke cigarettes at 22 percent, making tobacco use the most common preventable cause of death. This week's DM Update brings you a new cessation technique that shows promising results for tobacco quitters and improvements in stage classification methods for lung cancer patients.

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

This week's DM news:

Table of Contents

  1. Patch Doubles Quit Rate
  2. Lung Cancer Stages
  3. Medical Home Neighbor
  4. Engaging Clients for Behavior Change
  5. Healthcare Trends & Studies
  6. Virus Patterns Could Have Global Impact
  7. Health Coaching in '09

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Please send comments, questions and replies to lgreene@hin.com.

Melanie Matthews, mmatthews@hin.com

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Pre-Cessation Patch Doubles Quit Success Rate

Using a nicotine patch before quitting smoking can double success rates, according to Duke University Medical Center researchers. They say their latest data suggest changes should be made to nicotine patch labeling. The current labeling resulted from concerns that using a patch while smoking could lead to nicotine overdose. However, a literature review found concurrent use of a nicotine patch and cigarette smoking appears to be safe.

In an effort to find a successful smoking cessation method, 400 people who smoked an average of slightly more than one pack of cigarettes per day were put in four groups who either used a nicotine or placebo patch for two weeks prior to quitting smoking. Following the quit date, all groups received standard nicotine patch treatment at reduced dosages for a total of 10 weeks.

Twenty-two percent of participants in the pre-cessation nicotine patch groups abstained from smoking continuously for at least 10 weeks, compared to 11 percent in the placebo patch groups.

"People who use the patch before quitting are likely to spontaneously reduce the number of cigarettes they smoke because the patch satisfies their need for nicotine and makes the act of smoking less enjoyable," said Jed Rose, Ph.D., director of the Duke Center for Nicotine and Smoking Research. Research suggests using the patch before quitting also decreases withdrawal symptoms.

To learn more about this research, please visit:

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New Classification for Lung Cancer Stages Offers Hope to Patients

Lung disease experts have devised a new, more scientific system for classifying a patient's lung cancer stages. The original classification system was based heavily on intuition, with limited corroboration from a small patient database. The new system is more complex and based on data from 100,000 lung cancer patients from 20 countries. It scientifically analyzes the size of the primary tumor and the extent of its metastasis to lymph nodes or other organs.

"Definition of the stage is an essential part of the approach to patients with cancer," write authors Frank Detterbeck, M.D., Daniel Boffa, M.D. and Lynn Tanoue, M.D. Tanoue, co-director of the Yale Cancer Center Thoracic Oncology Program and Professor of Pulmonology at Yale School of Medicine. They also praise the new stage classification system, saying, "It is crucial for correctly gauging the extent of a patient's illness, so we can more precisely tailor the treatment or therapy to achieve a better outcome."

To learn more about this research, please visit:

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Meet the Medical Home Neighbor

The accountable care organization (ACO) — a network of PCPs, one or more hospitals and subspecialists that provide patient-centered care — is receiving increasing attention as healthcare reform unfolds. Not only do ACOs complement the medical home model, but they are inextricably linked, says Dr. Craig Samitt, M.B.A., president and CEO of Dean Health System. Dr. Samitt discusses how ACOs complement the medical home model, the pros and cons of mandatory and voluntary ACOs and creating reimbursement strategies for ACOs.

To listen to this complimentary HIN podcast, please visit:

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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 Karen Lawson, M.D., program director for the health coaching track at the Center for Spirituality and Healing, University of Minnesota.

Question: How do you engage your clients and keep them motivated to change their behavior?

Response: It’s important to recognize the incentive and where the motivation is coming from because it’s not the coach’s job to get them to change or to get them motivated. It’s a matter of trying to facilitate an individual doing what they want for themselves. You wouldn’t have a client unless they’d been assigned or sent to you by an outside entity, who wouldn’t have some desire to work in some direction of change themselves. That is one of the conflicts that arises: If someone’s being told that they need to participate in a program because of a work indication or a third-party payor, and they have no desire to be there themselves, you can’t motivate them. You can’t give a patient motivation that they don’t have.

For more information on engaging patients in behavior change, please visit:

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Tobacco Cessation Programs

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:

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New Transmission Patterns May Have Global Impect on Rotavirus Epidemics

New vaccines have the potential to prevent or temper epidemics of the childhood disease rotavirus, protect the unvaccinated and raise the age at which the infection first appears in children. The findings were based on changing patterns of rotavirus transmission in the United States, where the disease is rarely fatal, and they have implications for combating epidemics in other countries where the death toll is much higher.

The research is based on mathematical modeling that takes into account regional birth rates and predicted vaccination levels and effectiveness. The model suggests that when 80 percent or more of children in a given population are vaccinated, annual epidemics may occur on a less regular basis and more unvaccinated children will be protected.

“Rotavirus vaccines have rapidly and dramatically reduced hospitalizations and emergency room visits for gastroenteritis in American children,” said investigator Umesh D. Parashar, M.B.B.S., M.P.H., of the CDC's National Center for Immunization and Respiratory Diseases. “This research not only explains the effects of the U.S. rotavirus vaccination program, but also lays the foundation for understanding the tremendous life-saving benefits of vaccination in the developing world, where more than half a million children die from rotavirus each year.”

The study showed for the first time that the timing of rotavirus epidemics is dependent on the birth rate in the population because they are driven by infants who have never been infected before. But with the introduction of two vaccines, rotavirus outbreaks may become less frequent and less pronounced. They also may make their first appearance in children when they are older than the previous norm of less than 5 years of age, according to the research.

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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