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September 3, 2009 Volume VI, No. 16

HIN Communications Editor Laura Greene

Dear Healthcare Intelligence Network Client,

After the intial outbreak of the H1N1 virus this past spring, tensions around this flu eventually calmed, but an anticipated outbreak this fall is stirring healthcare concerns again. This week's Disease Management Update sheds some light on the public's opinion of the swine flu as well as steps they are taking to protect against the virus.

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

This week's DM news:

Table of Contents

  1. Public Believes Serious H1N1 Outbreak Likely
  2. Pregnant Women More Severely Impacted by Swine Flu
  3. Reducing Uncompensated Care Costs for the Chronically Ill
  4. Mobile Technologies
  5. Healthcare Trends & Studies
  6. Majority of Public Taking Steps against H1N1 Flu
  7. Telehealth in 2009

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Public Believes Serious H1N1 Outbreak Likely

Approximately six in 10 Americans (59 percent) believe it is very or somewhat likely that there will be widespread cases of Influenza A (H1N1) with people getting very sick this coming fall or winter. Parents are more likely than people without children to believe this will occur, with roughly two-thirds of parents (65 percent) saying it is very or somewhat likely compared to 56 percent of people without children.

"These results suggest Americans are likely to support public health officials in prioritizing preparations for the possibility of a serious H1N1 outbreak in the fall or winter," said Robert J. Blendon, professor of health policy and political analysis at the Harvard School of Public Health.

Despite a majority believing that a serious outbreak is likely, more than half of Americans (61 percent) are not concerned about their personal risk — that is, that they or their family members will get sick from H1N1 in the next year. The current survey further suggests that the World Health Organization (WHO)'s decision to raise the worldwide pandemic alert level to Phase 6 did not dramatically impact Americans' level of concern about their personal risk. Only 22 percent of Americans knew that the WHO had raised the level, and only 8 percent of Americans said it made them more concerned that they or their family would get H1N1 in the next 12 months.

If the outbreak in the fall or winter is serious and leads to large-scale workforce absenteeism, the survey suggests the possibility of substantial difficulties for many people and the economy as a whole. If people had to stay home for seven to 10 days because they were sick or because they had to care for a family member who was sick, 44 percent indicate that they would be likely to lose pay or income and have money problems, and 25 percent reported that they would be likely to lose their job or business.

"The findings highlight the important role that employers would play during a future outbreak. Flexibility in their employee policies may help minimize some of the problems identified in this survey," said Blendon.

To learn more about this research, please visit:

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Pregnant Women More Severely Impacted by H1N1 Virus

Pregnant women infected with 2009 novel H1N1 had a higher rate of hospitalization and greater risk of death than the general population due to the H1N1 flu, according to a study in the British medical journal Lancet. The data collected and analyzed by the CDC are the most comprehensive available to date on the impact of this novel H1N1 flu virus among pregnant women.

"The death of a pregnant woman is always heartbreaking, and unfortunately we have been hearing reports of otherwise healthy women dying from H1N1. If a pregnant woman feels like she may have influenza, she needs to call her healthcare provider right away," said CDC's Dr. Denise Jamieson, lead author of the study. "Clinicians who treat pregnant women should have a system in place for triaging pregnant women with influenza-like symptoms, and they should not delay in initiating appropriate antiviral therapy. Some clinicians hesitate treating pregnant women with antiviral medications because of concerns for the developing fetus, but this is the wrong approach. It is critical that pregnant women, in particular, be treated promptly."

Six deaths of pregnant women with H1N1 were reported to CDC between April 15 and June 16, 2009, representing 13 percent of the total 45 deaths reported to CDC during that time period. All were healthy prior to infection of H1N1 and subsequently developed primary viral pneumonia leading to acute respiratory distress requiring mechanical ventilation. All pregnant women who died did not receive antivirals soon enough to benefit their treatment. CDC recommends that pregnant women with suspected or confirmed influenza infection receive prompt treatment with antiviral medication.

Based on past influenza pandemics and on seasonal influenza epidemics, pregnant women have increased rates of illness and death from influenza infection. Despite recommendations from the Advisory Committee on Immunization Practices and the American College of Obstetricians and Gynecologists for inactivated flu vaccine for all pregnant women, seasonal flu vaccine coverage among pregnant women is very low (less than 14 percent).

To learn more about this research, please visit:

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Reducing Uncompensated Care Costs for the Chronically Ill

Increasingly, uninsured patients are seeking chronic care via the ER, where they are stabilized, possibly admitted and eventually discharged. However, this cycle is not conducive to managing chronic diseases, and, in the end, will result in high costs and poor quality of care for these individuals, says Dr. Ricardo Guggenheim, vice president of care management services at McKesson Health Solutions. Dr. Guggenheim discusses what areas stand to see improvements as a result of managed uncompensated care, why it is essential to invest in managing uninsured care costs and future plans for McKesson's Care Advisor program.

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Mobile Technologies for Health Improvement

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Paul Terry, Ph.D., president and CEO of StayWell Health Management.

Question: Are you seeing any increase in the use of text messaging or cell phones to communicate health improvement messages?

Response: We are all trying to work on any devices that we can to have more seamless flow back and forth between data that we collect in a health assessment, for example, and whatever these organizations provide via other push strategies. We see that migration is occurring; we look at social networks as well as another obvious venue for us. It will be a comprehensive combination of all of these approaches that will continue to grow our ability to be effective in the long-term.

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Healthcare Organizations React to MRSA Outbreak

The Association for Professionals in Infection Control and Epidemiology reported in 2007 that 1.2 million U.S. hospital patients are now affected with Methicillin-Resistant Staphylococcus Aureus bacteria (MRSA) each year. Cognizant of the rise in MRSA cases and increasing concern, the Healthcare Intelligence Network conducted a non-scientific online survey in October 2007 to determine what steps healthcare organizations are taking to prevent the infection.

To download this complimentary white paper, please visit:

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Majority of Public Taking Steps against H1N1 Flu Virus

A recent poll on the H1N1 (swine) flu conducted by the American Red Cross found that more Americans are taking or planning on taking extra measures to cover their coughs and sneezes with tissue (78 percent) or wash their hands more carefully (76 percent) to avoid getting the flu. The survey also found that 62 percent plan on being vaccinated against this new flu virus if one is offered. While only one in 10 of those surveyed by the Red Cross claimed to be very worried about swine flu, results show people have a strong interest in taking protective actions. The survey found that 93 percent of Americans are taking or planning to take at least one action to guard against this new flu. Nearly half of those surveyed (46 percent) plan on assembling a two-week supply of food, water and medicine that they might need in the event they or someone in their family becomes sick and need to stay home for extended periods of time.

"Even though most Americans aren't extremely worried about the virus, they seem interested in taking steps to protect themselves and their families," said Scott Conner, Red Cross senior vice president of preparedness and health and safety services. "Taking those basic steps — such as washing your hands more frequently and remaining at home if you are sick become even more important as the new flu season approaches."

The survey results also found that women are more likely to take protective actions, with 84 percent making an extra effort to cover coughs and sneezes (versus 71 percent for men), and 81 percent washing their hands more carefully and more often (compared to 71 percent for men). As with any emergency, the Red Cross encourages people to prepare by getting an emergency kit, making a plan and being informed. Later this fall, the Red Cross will be releasing a pandemic flu educational program for small businesses to help raise awareness and educate workplaces on what to expect and how to plan for a pandemic. Smaller companies often operate with fewer resources and limited capacity compared to their larger counterparts and can be particularly at risk for disruptions resulting from a flu pandemic.

To learn more about this research, please visit:

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Telehealth in 2009

While rising healthcare costs fuel much of the healthcare reform debate, many healthcare organizations are turning to telehealth to lower costs and improve efficiencies while expanding patients' access to services. Complete HIN's Survey of the Month on Telehealth in 2009 by September 30 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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