Disease Management Update
Volume V, No. 14
July 31, 2008
Dear Healthcare Intelligence Network Client,
In the United States alone, 6 million individuals suffer from some form of a degenerative neurological condition. An estimated 1.5 million suffer from Parkinson's Disease (PD), while 30,000 mdash; an estimated one in 10,000 mdash; suffer from Huntington's Disease (HD). Moreover, an additional 150,000 individuals face at least a 50 percent risk of developing HD. With these numbers in mind, this week's Disease Management Update looks at PD and HD and some new findings that may lead to better treatment of these near-fatal neurological diseases.
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Table of Contents
- Genetic Mechanisms Linked to PD
- Disease Management Q&A: Integrating Utilization and Mental Health Responsibilities
- HealthSounds Podcast: Decreasing Mental Health-related ER Use
- HD Linked to Overactive Immune Response in Brain
- Survey of the Month: Last Day to Report Energy Costs in Healthcare
- Patient Registries: The Track to Better Quality Healthcare
1. Genetic Mechanisms Linked to PD
New research shows that the buildup of a certain protein is responsible for controlling the production of the gene, alpha-synuclein, which is a cause of PD. This finding, from Brigham and Womenís Hospital (BWH), the University of Wisconsin School of Medicine and Public Health (SMPH) and the University of Ottawa, may help pave the way for the discovery of therapies that could effectively treat PD.
PD patients have clumps of alpha-synuclein in their brains. High levels of this protein kill off dopamine neurons and cause tremors and other symptoms of PD. While looking at blood tests for PD, researchers noticed high levels of alpha-synuclein in the blood. Because alpha-synuclein was previously thought to be a gene found in the brain, its presence in the blood was surprising. Seeking to uncover the reason for the presence of this gene in blood, they used gene chips to look at whether or not any of the thousands of other genes active in blood was linked to alpha-synuclein. They discovered that there are actually three genes — heme genes — that are responsible for carrying oxygen and transporting electrons through the blood, whose activity was in lock step with the activity of the alpha-synuclein gene.
ďThis discovery is exciting because it allows for a paradigm shift in how researchers can search for a cure for Parkinsonís disease," said Clemens Scherzer, M.D., a neurologist and researcher at BWH. "So far research has focused on ways to get rid of excess alpha-synuclein that is built up in the brain of patients with Parkinsonís. Now, we can look for ways to lower the production of alpha-synuclein up front."
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2. Disease Management Q&A: Integrating Utilization and Mental Health Responsibilities
Each week, a healthcare professional responds to a reader's query on an industry issue. This week's experts are Diane Flanders, director of coordinated care systems at MassHealth, and Sarah Keenan, clinical liaison with Medica.
Question: In considering care transitions, how have you managed and integrated utilization review (UR) responsibilities, and how is mental health managed in both of those situations?
Response: (Diane Flanders) The UR responsibilities are within the organization itself. There are the classic mechanisms for sub-contracting, receiving and managing claims. They authorize those services, and then the claiming process is the way that they measure that. We made a big focus on mental health. Historically, this has been a real problem for seniors — them not accessing a mental health system — so we put a lot of work into this. For the non-elderly in Massachusetts, we have a behavioral health contract, which serves people with mental illness and substance abuse in a variety of very creative ways. These can include partial hospitalization, day-care settings and community-based services that really arenít available in the traditional Medicare-Medicaid world. We just lifted those requirements and put them right into the package.
Now, all three of the senior care organizations have sub-contracted to varying extents with mental health companies so that they are purchasing that expertise. But we made a big point of saying that they needed to have their policies and procedures around that mental health fit in with a geriatric expertise, so that is part of the requirement, too. It is certainly a very important element, and weíre seeing an increase in utilization over what we see in fee for service. Thatís what we expected to see. Itís not very big at this point, but we think we should be seeing more services in that area.
(Sarah Keenan) The UR is done per care system, following the financial risk. It tends to be retrospective as opposed to prospective, and it varies per the care system. Certainly, most of those standard UR mechanisms would apply to this program as well. Medica contracts with a mental health vendor for their expertise. In this past year, weíve contracted with our Minnesota counties for the first time to do our care coordination. Itís added to the expertise level, particularly on the mental health side, because of their relationship with their targeted mental health case managers. Itís opened doors to so much information sharing, and weíve made great strides on the mental health front. We have a long way to go, but weíre seeing improvements in it.
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3. HealthSounds Podcast: Decreasing Mental Health-related ER Use
East Jefferson General Hospital (EJGH) is doing things a little differently to try to reduce ER usage among their mental health patients. According to Joe Eppling, assistant vice president of post acute and behavior health services for EJGH, placing a psychiatric nurse in the ER around the clock enables hospital staff to really know the population they are treating, and in turn reduce ER "super users." Eppling also discusses the effect medical homes and transitional care units could have on the mental health population and suggests optimal ER wait times for this population.
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HD Linked to Overactive Immune Response in Brain
The damage to brain tissue seen in Huntington's disease may be caused by an overactive immune response in the bloodstream and the brain, according to new findings from the University of Washington (UW) and University College London. Working separately, the two teams found evidence in both brain cells and the bloodstream suggesting an important link between the immune system's response and HD. Together, the findings may help scientists find biological markers for monitoring the disease progression earlier and with more accuracy, and could help them develop new treatments for the disease.
Researchers found that patients with HD had higher levels of immune-system signaling molecules, called cytokines, in their brain tissue. The UW researchers looked at a mouse-based model of the disease, studying the response of microglia, the immune cells of the nervous system. When the microglia were treated with a molecule triggering an immune response, the microglia from Huntington's mice produced much higher levels of cytokines, the immune system molecules. That finding suggests that the protein produced by the HD genetic mutation, a protein called huntingtin, is causing the immune cells to be overactive. The researchers think that overly strong immune response may be the mechanism through which the disease causes damage to neurons in the brain.
"Inflammation in the brain has been increasingly recognized as an important component in other neurodegenerative diseases such as Alzheimer's or Parkinson's disease," said Dr. Thomas Moeller, research associate professor of neurology. "These findings might open the door to novel therapeutic approaches for Huntington's disease that target inflammation."
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5. Survey of the Month: Last Day to Report Energy Costs in Healthcare
According to the Environmental Protection Agency, healthcare organizations spend over $6.5 billion on energy each year to meet patients' needs while experiencing double-digit cost increases. In addition, rising gas prices are affecting healthcare administration and utilization. Today is the last day to complete our survey on energy costs in healthcare in order to receive a free summary of the compiled results and $25 off the price of the full study when it is published in September. Also, the respondent who submits the most effective energy conservation/cost-saving strategy will receive a $50 gas card!
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6. Patient Registries: The Track to Better Quality Healthcare
Patient registries are clinical information systems physicians use to identify and track patients with a defined disease or condition. And itís no wonder why healthcare providers are using them — in addition to creating realistic views of clinical practices, patient outcomes, safety and comparative effectiveness and supporting evidence development and decision-making, patient registries are associated with improved care for patients with chronic diseases.
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