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August 27, 2009 Volume VI, No. 15

HIN Communications Editor Laura Greene

Dear Healthcare Intelligence Network Client,

Heart disease and gestational diabetes — two conditions that affect women in the United States — are the topics of this week's DM Update. A new study shows a possible link between heart disease — the number one killer of women in the United States and Canada — and gestational diabetes, while a hospital's heart failure (HF) program has shown promising results by substanially decreasing hospital admissions for HF patients.

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

This week's DM news:

Table of Contents

  1. HF Admissions
  2. Predicting Heart Disease
  3. Medical Home Reimbursement
  4. Patient Self-Care
  5. Healthcare Trends & Studies
  6. Crohn's Disease
  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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Hospital Reduces Admissions HF Admissions

Preliminary results of the Inova Mount Vernon Hospital HF program reduced expected all-cause hospital admissions for enrolled HF patients by 75 percent just six months after program launch at the 237-bed hospital in Virginia. Inova began using Tel-Assurance™, Pharos Innovationsí device-free remote patient monitoring (RPM) platform, in November 2008 as part of its program.

Other results achieved for enrolled Inova patients (compared to those not enrolled) included 95 percent lower all-cause admission rates, 31 percent lower all-cause admission average length of stay (ALOS) and a cost decrease due to a shift in admission acuity levels and commensurate decrease in ALOS.

Despite diversity in geography and populations served, Tel-Assurance clients nationwide, generate admission rates well below national averages. Lowering these rates by averting unnecessary hospitalizations reduces healthcare costs — a key aim of the national healthcare reform discussions.

ďIf Inova can reduce admissions for program participants by 75 percent in the beginning of the program, imagine the possible reductions with a larger population enrolled,Ē said Randall E. Williams, MD, CEO of Pharos Innovations. ďBecause of this early success, Inova has already expanded the program to two additional hospitals and there are plans to add two more by 2010. We look forward to seeing those results as well.Ē

To learn more about this research, please visit:

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Glucose Challenge in Pregnancy Could Predict Heart Disease

A glucose challenge test given to pregnant women may also show if they have an increased risk of heart disease in the future, a new study from the Institute for Clinical and Evaluative Sciences in Toronto has found. This finding is important because doctors might be able to begin using current screening procedures for gestational diabetes to identify women who are at risk for developing heart disease later in life, the researchers said. Heart disease is the number-one killer of women in the United States and Canada.

While women with gestational diabetes have a higher risk of cardiovascular disease than those without, no one knew if mild glucose intolerance in pregnancy is associated with heart disease, the study authors noted. Gestational diabetes is an important risk factor for future type 2 diabetes. Pregnant women are generally screened for gestational diabetes with a glucose challenge test in the second trimester. If the result is abnormal, they have an oral glucose tolerance test to confirm the diagnosis, according to a news release published in the current issue of the Canadian Medical Association Journal. For the study, researchers examined data on 435,696 women who gave birth between April 1994 and March 1998. All of the women were followed until March 31, 2008, and the study excluded women who had preexisting diabetes.

"Women who had an abnormal glucose challenge test but then did not have gestational diabetes had an increased risk of future cardiovascular disease compared to the general population, but a lower risk than women who actually did have gestational diabetes," study co-author Dr. Baiju Shah said in a news release from the journal's publisher.

To learn more about this research, please visit:

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Medical Home Improvement

Healthcare reform partially fueled Baptist Health System's desire to participate in the CMS Acute Care Episode (ACE) pilot that is testing bundled or episodic payments for selected orthopedic and cardiac procedures, explains Michael Zucker, Baptist's chief development officer. He describes some early returns from the experience, highlights the provider's role in Baptist's multi-pronged awareness campaign for Medicare beneficiaries and explains the committee-based approach to quality change and cost savings that has already improved communications among participating providers.

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Teaching Patients Self-Care

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Janet Tomcavage, R.N., M.S.N., vice president of health services for Geisinger Health Plan.

Question: What is the value of teaching patients self-care and self-management?

Response: With many chronic conditions, so much of the management is in the home by the patient and/or family. If I have diabetes, then Iím really accountable for my care. So many of the decisions that I make at home reflect my outcome — whether I check my blood glucose enough times during the day, count my carbohydrates appropriately and take my medicine in a timely manner to coordinate with my carbohydrates. That self-care and self-management is also critical for heart failure patients. If I donít watch my sodium, if I donít step on that scale every morning, if I donít take my diuretics — so much of the exacerbation that drives hospital and medical admissions is around either lack of appropriate home care or a lack of symptom monitoring — monitoring the symptoms of my condition so that I know when things are starting to get out of line.

For more information on benchmarks and case studies in patient-centered care, please visit:

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Improving Care & Reducing Costs in Healthcare

The patient-centered medical home (PCMH) model of care — an approach embraced by thousands of healthcare organizations — focuses on improving care quality and reducing costs for the chronically ill. According to a 2004 report in the Annals of Family Medicine, if every American had a medical home, healthcare costs would decrease by 5.6 percent, resulting in national savings of $67 billion per year and improved care. This white paper summarizes the results from HINís Medical Homes in 2009 e-survey in which more than 220 healthcare organizations described the role of the PCMH in their organizations.

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Emory to Study Crohn's Disease in Children

Emory University and Children's Healthcare of Atlanta pediatric gastroenterologist Subra Kugathasan, M.D., has received a four-year, $5 million grant from the Crohn's & Colitis Foundation of America (CCFA) to study the progression of Crohn's disease in children.

The multi-center study will enroll approximately 1,100 children, all recently diagnosed with Crohn's disease, from more than 20 pediatric centers across North America. The purpose of this study is to identify biomarkers found in the blood or stool to predict which children with Crohn's disease are most at risk for developing complications from the disease.

"It is estimated that 15 percent to 20 percent of children with Crohn's disease will develop complications that may require surgery within the first three years of diagnosis," says Dr. Kugathasan, study principal investigator and professor of pediatrics in the Emory School of Medicine.

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. Only a few days remain to complete HIN's Survey of the Month on Patient Education and Outreach and receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

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