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August 13, 2009 Volume VI, No. 13

HIN Communications Editor Laura Greene

Dear Healthcare Intelligence Network Client,

In the fast-paced society we live in today, healthy habits are too often substituted by what's quick and convenient. But this week's DM Update illustrates how a healthy lifestyle can reduce one's risk of some serious diseases. Read on to find out how to reduce the chances of these conditions.

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

This week's DM news:

Table of Contents

  1. High Cholesterol in Midlife Raises Risk of Late-Life Dementia
  2. No Link Between Cognitive Decline, Socioeconomic Status in Elderly
  3. Medical Home Highlights
  4. Measuring Care Improvement
  5. Healthcare Trends & Studies
  6. Healthy Habits & of Chronic Disease
  7. Patient Education & Outreach

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High Cholesterol in Midlife Raises Risk of Late-Life Dementia

A four decade study of 9,844 men and women from the Kaiser Permanente’s Division of Research and the University of Kuopio in Finland found that elevated cholesterol levels in midlife — even levels considered only borderline elevated — can increase the risk of Alzheimer’s Disease (AD) later in life, according to researchers at Kaiser Permanente’s Division of Research and the University of Kuopio in Finland. The study found that having a high cholesterol in midlife (240 or higher milligrams per deciliter of blood) increases, by 66 percent, the risk for Alzheimer’s disease later in life by as much as 66 percent.

The study measured cholesterol levels in 1964 to 1973 based on the 2002 Adult Treatment Panel III guidelines (the current practice standard) when the Kaiser Permanente Northern California members were 40 to 45 years old and then followed the participants for 40 years.This study is the largest long-term study with the most diverse population to examine the midlife cholesterol levels and late-life dementia. It is also the first study to look at borderline high cholesterol levels and vascular dementia, rather than just AD.

“Our study shows that even moderately high cholesterol levels in your 40s puts people at greater risk for Alzheimer’s disease and vascular dementia decades later,” said the study’s senior author, Rachel Whitmer, Ph.D., a research scientist and epidemiologist at the Kaiser Permanente Division of Research in Oakland, Calif. “Considering that nearly 100 million Americans have either high or borderline cholesterol levels, this is a disturbing finding. The good news here is that what is good for the heart is also good for the mind, and this is an early risk factor for dementia that can be modified and managed by lowering cholesterol through healthy lifestyle changes.”

To learn more about this research, please visit:

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No Link Between Cognitive Decline, Socioeconomic Status in Elderly

New UCLA research suggests that for seniors age 70 and older, socioeconomic status does not play a major role in the brain's continued ability to function. However, seniors who have never been married and widowers seem to perform more poorly as they age. Previous studies on age-related cognitive decline have not adequately clarified the role demographics and socioeconomic status might play in the rate of decline. Some small and short-term studies have found small socioeconomic differences in decline rates, while others have shown none at all, leaving the issue murky at best.

"It has been known that cognitive performance at any given age appears to depend on demographic characteristics; the more educated, for instance, perform better," said lead investigator Dr. Arun Karlamangla, associate professor of medicine in the division of geriatrics at the Geffen School of Medicine. "But though there are differences in the level of performance you start with in your late 60s, this study's surprise is that the rate of decline in your 70s is the same for every group."

The study was based on data from 6,476 adults born prior to 1924 culled from the Study of Assets and Health Dynamics Among the Oldest Old (AHEAD). Participants were tested five times between 1993 and 2002 on various memory and cognition items, including word recall, the "serial sevens" subtraction test, orientation to time, attention, language and knowledge of current affairs. The study found evidence of a link between socioeconomic status (SES) and cognition, but only at baseline — that is, the first test. Those with high SES performed better on the first assessment than those with middle SES, who in turn performed better than individuals with low SES. These differences, researchers said, could be linked to the effects of education, such as learned test-taking strategies and the possible direct effects of education on brain structure. Researchers did find some demographic variation in rates of cognitive decline, with older participants declining faster than younger ones, and widows and widowers and those who never married declining faster than married individuals.

To learn more about this research, please visit:

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Focus on Care Continuity, Quality and Access

The opening sessions of the Medical Home Open House webinar series delivered tips for improving care continuity, quality and access for patients assigned to a medical home.

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Measuring Patient Engagement

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is James Hardy, senior vice president of care management services, McKesson Health Solutions.

Question: What is the best way to measure the impact of comorbidity reduction in DM?

Response: There are probably two different ways to do that, depending on the sophistication of the payor of the program. Certainly looking at whether you’ve been able to reduce anticipated costs is a good marker. It’s also important to look at HEDIS standards for the population — are you making a difference? Use existing clinical metrics to evaluate changes in the population. You need to have a broad-based program to have some significant measurement, but those are two different ways to try to approach that on a fundamental level.

For more information on comorbidity care models, please visit:

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Care Transitions Across Sites: Closing Gaps in Healthcare Settings

When transitioning patients from one healthcare setting to another, it’s not uncommon to encounter gaps in care that have the potential to negatively impact their health. To remedy this problem and reduce associated costs, organizations are taking steps to better plan for a patient’s care transitions and close these gaps in care. These simple strategies can have a significant effect on health outcomes, likelihood of readmission and ER visits, cost to patients, providers and insurers and the burden on caregivers and family members. This white paper from the Healthcare Intelligence Network (HIN) is based on HIN’s April 2009 e-survey in which respondents were asked to share their organization’s experiences with care transitions.

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Healthy Habits May Be Associated With Reduced Risk of Chronic Disease

Four healthy lifestyle factors — never smoking, maintaining a healthy weight, exercising regularly and following a healthy diet — together appear to be associated with as much as an 80 percent reduction in the risk of developing the most common and deadly chronic diseases. Researchers from the CDC assessed data from 23,513 German adults age 35 to 65. At the beginning of the European Prospective Investigation Into Cancer and Nutrition–Potsdam (EPIC-Potsdam) study — between 1994 and 1998 — participants completed an assessment of their body weight and height, a personal interview that included questions about diseases, a questionnaire on sociodemographic and lifestyle characteristics and a food frequency questionnaire.

Most participants had one to three of these health factors, fewer than 4 percent had zero healthy factors and 9 percent had all four factors. Over an average of 7.8 years of follow-up, 2,006 participants developed new cases of diabetes (3.7 percent), heart attack (0.9 percent), stroke (0.8 percent) or cancer (3.8 percent). Individuals with more healthy lifestyle factors were less likely to develop chronic diseases. Participants who had all four factors at the beginning of the study had a 78 percent lower risk of developing any of the chronic diseases during the follow-up period than those who had none of the healthy factors. The four factors were associated with a 93 percent reduced risk of diabetes, 81 percent reduced risk of heart attack, 50 percent reduced risk of stroke and 36 percent reduced risk of cancer.

The largest reduction in risk was associated with having a BMI lower than 30, followed by never smoking, at least 3.5 hours of physical activity per week and then adhering to good dietary principles.

"Our results reinforce current public health recommendations to avoid smoking, to maintain a healthy weight, to engage in physical activity appropriately and to eat adequate amounts of fruits and vegetables and foods containing whole grains and to partake of red meat prudently," the authors write. "Because the roots of these factors often originate during the formative stages of life, it is especially important to start early in teaching the important lessons concerning healthy living."

To learn more about this research, please visit:

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Patient Education and Outreach

Educating patients about their health conditions, plan of care and wellness and prevention strategies not only empowers them to manage their condition and care but also can reduce medical complications, medication costs and unnecessary healthcare utilization. Complete HIN's Survey of the Month on Patient Education and Engagement by August 31 and receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

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