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August 20, 2009 Volume VI, No. 14

HIN Communications Editor Laura Greene

Dear Healthcare Intelligence Network Client,

Today's health improvement climate advocates a patient-centered approach in a coordinated care setting. That doesn't mean, however, that patients are relieved of responsibility for their health status. This week's DM Update explains why it pays for today's patient not only to be active but also activated.

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

This week's DM news:

Table of Contents

  1. Improving Medication Adherence
  2. Finding Early Signs of Cancer
  3. PAM Not Just for Patients
  4. The Ideal Patient
  5. Healthcare Trends & Studies
  6. Avoiding Alzheimer's
  7. Patient Education & Outreach

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

Melanie Matthews, mmatthews@hin.com

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Out-of-the-Pillbox Thinking Can Improve Medication Adherence, Says NEHI Report

Four key actions can reduce medication non-adherence in patients, a problem that costs the U.S. healthcare system about $290 billion annually, according to a new report from the New England Healthcare Institute (NEHI). "Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease," suggests four ways to improve patient medication adherence as part of health reform efforts, including:

  • Healthcare Teams: The creation of care teams — incorporating nurses, care managers, pharmacists and other clinicians within or outside the physician’s practice — increases the number of touchpoints for patients, offering repeated checks on their adherence as they move through the healthcare system.

  • Patient Engagement and Education: Counseling by PCPs to ensure that patients understand their disease and the important role of their medication in improving their condition is critical to motivating patients towards sustained adherence.

  • Payment Reform: Realigning reimbursement incentives away from rewarding volume and towards rewarding good outcomes would encourage providers to strive for improved outcomes by way of improved adherence, as would performance-based or global service reimbursements. Payment reform would encourage providers to invest in resources such as counseling services that would improve patient outcomes by increasing medication adherence.

  • Health IT: EHRs, e-prescribing and clinical decision support systems would ensure that complete and accurate medication data are shared among all the key players, including patients, prescribing physicians and pharmacists. For instance, a patient medication profile available through a health IT system would give providers a full sense of a patient’s current medications and, if linked to a pharmacy system, would indicate whether a patient filled or refilled a given medication.

The NEHI found that one-third to one half of all patients do not take their medications properly. Patients with chronic diseases are particularly susceptible to spotty adherence practices that leave them vulnerable to unnecessary hospitalizations and additional medical risks. According to one study of diabetes and heart disease patients cited by NEHI, mortality rates among patients who did not adhere to their medications were nearly double the rates of those who took their medications as prescribed.

To learn more about this research, please visit:

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New DNA Test Uses Nanotechnology to Find Early Signs of Cancer

Using tiny crystals called quantum dots, Johns Hopkins researchers have developed a highly sensitive test to look for DNA attachments that often are early warning signs of cancer. This test, which detects both the presence and the quantity of certain DNA changes, could alert people who are at risk of developing the disease and could tell doctors how well a particular cancer treatment is working. The new test was reported in a paper published in the August issue of the journal Genome Research and presented at a conference of the American Association of Cancer Research.

Jeff Tza-Huei Wang, an associate professor of mechanical engineering, developed the test over the past three years with colleagues at the Johns Hopkins Kimmel Cancer Center. The recent study, which included the detection of DNA markers in the sputum from lung cancer patients, was designed to show that the technology was sound. Compared to current methods, the test appeared to be more sensitive and delivered results more quickly, the researchers said, and could easily be in wide use within the next five years.

The target of this test is a biochemical change called DNA methylation, which occurs when a chemical group called methyl attaches itself to cytosine, one of the four nucleotides or base building blocks of DNA. When methylation occurs at critical gene locations, it can halt the release of proteins that suppress tumors, which makes it is easier for cancer cells to form and multiply. As a result, a person whose DNA has this abnormal gene DNA methylation may have a higher risk of developing cancer. Furthermore, these methylation changes appear to be an early event that precedes the appearance of genetic mutations, another precursor to cancer.

“This kind of information could allow a patient with positive methylation to undergo more frequent cancer screening tests. This method could replace the traditionally more invasive ways for obtaining patient samples with a simple blood test,” said Vasudev J. Bailey, a biomedical engineering doctoral student from Bangalore, India, one of two lead authors on the research paper. “It’s also important because these test results could possibly help a doctor determine whether a particular cancer treatment is working. It could pave the way for personalized chemotherapy.”

In addition, because different types of cancer exhibit distinctive genetic markers, the researchers say the test should be able to identify which specific cancer a patient may be at risk of developing. Markers for lung cancer, for example, are different from markers for leukemia.

To learn more about this research, please visit:

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PAM Not Just for Patients

American Health Holding relies on the Patient Activation Measure™ (PAM) not only to assess a patient’s level of engagement in their own disease self-management but also to gauge the success of the DM program and its coaches. Director of DM and wellness services Diane Bellard explains who is using PAM, how to deal with a decrease in PAM levels, how it fits with a patient's readiness to change and PAM's role in quality improvement.

To listen to this complimentary HIN podcast, please visit:

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Defining the Ideal Patient

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Dr. Edward Phillips, M.D., director of outpatient medical services at Spaulding Rehabilitation Hospital Network and assistant professor of the Department of Physical Medicine and Rehabilitation at Harvard Medical School.

Question: How would you define the ideal patient?

Response: (Dr. Edward Phillips) There’s no correlation to gender, race, creed, age, socioeconomic class —- none of those things. The patients that walk in and say, “I have a problem and I need your expert advice. I need to know what it is and what it isn’t. I need to know what I can do about it. I need your advice on what you recommend I do about it. I’ll take over from there” is an ideal patient. They’re looking for advice. One woman who came in was overweight and her knees hurt. I took care of her knees and I said, “Gee, if you lost a little weight it would take the stress off your knees.” She said, “What do I have to do?” I said, “Smallest change. Why don’t you cut out the soda pop that you’re drinking?” She came back a couple of months later 15 pounds lighter. I said, “What can I do for you?” She said, “What do I do next? I’m engaged, my life is moving in the right direction, what do you recommend next?” That’s an ideal patient.

For more information on enlisting physicians in wellness and prevention efforts, please visit:

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Patient Registries: The Track to Better Quality Healthcare

Patient registries are clinical information systems that physicians use to identify and track patients with a defined disease or condition. Besides creating realistic views of clinical practices, patient outcomes, safety and comparative effectiveness, patient registries support evidence development and decision-making and are associated with improved management of chronic illness.

To download this complimentary white paper, please visit:

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Mixing Exercise and Mediterranean Diet May Lower Alzheimer's Risk

Both being more physically active and adhering to a Mediterranean-type diet appears to be associated with reduced Alzheimer’s risk, according to a new report in the Journal of the American Medical Association (JAMA). While previous studies have only investigated the association between either physical activity or diet and Alzheimer’s disease risk separately, this new research explored their combined association.

This population-based study in a multi-ethnic community living in Northern Manhattan observed 1880 elderly subjects with an average age of 77. The participants were interviewed about their level of physical activity and dietary habits, and their responses were then summarized into two single scores. The study subjects were then followed to observe which subjects went on to develop Alzheimer’s over the course of approximately five and a half years.

The study found that those subjects who were very physically active had a 33 percent risk reduction of Alzheimer’s; those who adhered more strongly to a Mediterranean-type diet had a 40 percent risk reduction. In addition, Dr. Nikolaos Scarmeas, M.D., of Columbia University Medical Center, New York, and his colleagues found that there was a gradual decreasing risk for Alzheimer’s in study participants who were reporting that they were both exercising a lot and following a diet closer to the Mediterranean-type: those subjects had a 60 percent reduction in their risk for developing Alzheimer’s disease.

To learn more about this research, please visit:

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Patient Education and Outreach

An investment in patient education can pay off in a more activated patient as well as fewer medical complications, medication costs and unnecessary healthcare utilization. More than 75 organizations have already responded to HIN's Survey of the Month on Patient Education and Outreach efforts. Add your responses by August 31 and you can 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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