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September 24, 2009 Volume VI, No. 19

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

Diabetes care is the main cause for concern in this week's issue of the Disease Management Upate. According to a report from Texas, this state is experiencing a higher percentage of patients being diagnosed with Type 2 diabetes compared to national averages. This report also ranks Texas in terms of cost of treatment, care and patient compliance with medication. While on the topic of diabetes medication, a related story discusses the impact of insulin or the diabetes drug Metformin on inflammatory biomarkers and glucose levels in patients with type 2 diabetes.

And finally, despite fear of H1N1, some Americans are still not practicing good hand hygiene. Find out how the fifth annual Clean Hands Report Card® graded America on hand hygiene this year compared to last year.

Your colleague in the business of healthcare,
Jessica Papay
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. Diabetes Care Costs in Texas
  2. Insulin Treatment and Inflammatory Reduction
  3. Diabetes Medical Home
  4. Marketing the Diabetes Medical Home
  5. Healthcare Trends & Studies
  6. Americans Get a “B-” on Hand Hygiene
  7. Telehealth in 2009

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

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Diabetes in Texas: Growing Severity of Problem, Higher Cost of Care than National Average

A new report from The Texas Business Group on Health (TBGH) shows that when it comes to the use of evidence-based medical care for Type 2 diabetes patients, such as A1c tests, cholesterol tests and eye exams, Texas continues to rank lower than the national averages. This report includes information for key local markets across the state including Austin, Dallas, El Paso, Fort Worth/Arlington, Houston and San Antonio. Also included are state and national benchmarks that can help providers and employers identify better opportunities to serve the needs of their patients and employees.

In 2008, the number of patients diagnosed with Type 2 diabetes rose sharply across Texas, perhaps suggesting a worsening epidemic, but also greater awareness of diabetes risks and more aggressive diagnosing. The highest increase in prevalence was in El Paso, where 74 percent more individuals were diagnosed with Type 2 diabetes in 2008 than the year before. Other communities that also had relatively large increases in prevalence include Houston (41percent); Austin (34 percent); and Dallas (31 percent).

The cost of treating commercially insured Type 2 diabetes patients in Texas hospitals in 2008, regardless of setting (inpatient, outpatient, emergency room), exceeded the national averages. In fact, inpatient charges were 20 percent higher than the national average of $52,730, and an 11 percent increase over Texas hospitals’ 2007 inpatient charges of $56,765 per Type 2 diabetes patient. Houston had the highest hospital inpatient charges for Type 2 diabetes patients at $62,816 per patient, which is a 13 percent increase over the year before. The lowest cost market was Ft. Worth/Arlington, where Type 2 diabetes inpatient charges were $52,243, which is a surprising 10 percent drop from the year before (2007).

To learn more about this research, please visit:

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Insulin or Metformin Does Not Reduce Inflammatory Biomarkers for Some Diabetic Patients

In patients with recent onset type 2 diabetes, treatment with insulin or the diabetes drug Metformin did not reduce inflammatory biomarkers, such as high-sensitivity C-reactive protein (hsCRP), although the treatment did improve glucose control, according to a study in a recent issue of JAMA. As diabetes is in part an inflammatory condition, a possible therapeutic target for patients is subclinical inflammation, a modifiable risk factor. Evidence is limited on whether improvement in glycemic control, insulin resistance, or both with antidiabetic agents such as insulin and Metformin may beneficially change inflammation.

The study included 500 adults with suboptimal glycemic control and elevated hsCRP levels. Participants were randomized to one of four treatments: placebo Metformin only; placebo Metformin and insulin; active Metformin only; or active Metformin and insulin. The researchers noted the change in the measurement of the inflammatory biomarkers from the beginning of the trial to 14 weeks.

According to the authors, “No consistent association was found between glucose reduction and improvement in inflammatory status ascertained by change in levels of hsCRP and other biomarkers. Despite substantially improving glucose control, neither insulin nor Metformin reduced inflammatory biomarker levels for the main effects evaluated or in comparisons between the individual treatment groups. An interaction between interventions was observed such that, compared with no pharmacologic intervention, those allocated to insulin alone had a significant attenuation of inflammation reduction, an effect not observed among those allocated to Metformin and insulin or to Metformin alone.”

To learn more about this research, please visit:

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Diabetes Medical Home — Patient Action Plans and Provider Toolkits

Roberta Burgess, nurse case manager for Community Care Plan of Eastern North Carolina through Heritage Hospital in Tarboro, N.C., describes the contents of Community Care Plan's provider toolkits and patient diabetes action plans, both key communication vehicles in its diabetes patient-centered medical home (PCMH) project. She also details the duties of case managers, who form another vital link in the DM chain that saved North Carolina $231 million in healthcare costs in 2005 and 2006.

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Marketing the Diabetes Medical Home

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Dr. James E. Barr, medical director for Partners in Care.

Question: What type of marketing message entices diabetics to check out the medical home model?

Response: On the physician side, being NCQA-recognized as a PCMH is something that you could market not just to the diabetics, but to any patient who can benefit from a PCMH approach. With my own practice, we’re starting to educate the patients about the PCMH and what it means. You have to make sure that you are not marketing a gatekeeper concept. They’re all afraid of that terminology. You have to stay far away from the gatekeeper concept. The PCMH isn’t there to stop them from getting care; it’s to help them get care and arrange care.

For more information on building a diabetes medical home, please visit:

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Despite Concern Over H1N1, Americans Get a “B-” on Hand Hygiene

Americans appear to be embracing hand hygiene more than in past years. But not all of us are cleaning our hands as often as we should — especially with the threat of the H1N1 flu virus. In the fifth annual Clean Hands Report Card® issued by The Soap and Detergent Association (SDA), America’s grade for hand hygiene has risen from a “C-minus” in 2008 to a “B-minus.” Survey results recently released by SDA show that nearly two-thirds of adults (65 percent) expressed concern about H1N1 flu (women more than men: 72 percent, 57 percent, respectively). But only one-third of respondents said they changed their overall hygiene habits in response to the growing concerns about H1N1.

Among the good news of SDA’s 2009 survey: 50 percent say they wash their hands more than 10 times per day (up from 36 percent) and 70 percent wash up at least seven times per day (up from 62 percent). Across the board, more Americans claim to always wash their hands before eating lunch, after coughing or sneezing and after using the bathroom.

Some bad news of SDA’s 2009 survey include, that while 62 percent of women are washing more than 10 times per day, only 37 percent of men are doing the same. Thirty-nine percent of respondents seldom or never wash their hands after coughing or sneezing (on par with 2008) and 46 percent of respondents wash their hands for 15 seconds or less (on par with 2008). The CDC and SDA recommend washing with soap and water for at least 15-20 seconds.

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. Join the more than 70 organizations that have completed 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.

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