Disease Management Update
Volume V, No. 22
September 25, 2008

Dear Healthcare Intelligence Network Client,

According to the Ohio State University Medical Center, chronic pain costs the U.S. healthcare system an estimated $90 billion a year in direct medical expenses, lost income, lost productivity, compensation payments and legal charges. This week's Disease Management Update looks at two discoveries involving arthritis pain and hears from some key leaders in the pain management arena.

And visit HIN's blog to read about what the Joint Commission is doing to help chronic pain sufferers ďspeak up" about their conditions.

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

Please pass this along to any of your colleagues or, better yet, have them sign up to receive their own copy at http://www.hin.com/freenews2.html where you can also learn about our other complimentary news services.

Table of Contents

  1. Six New Genetic Indicators for Rheumatoid Arthritis
  2. Disease Management Q&A: Pain Management and the PCP
  3. HealthSounds Podcast: Caring for Medicare Patients
  4. Sinusitis Patients Have Pain Similar to the Elderly and People with Arthritis
  5. Survey of the Month: Healthcare Trends in 2009
  6. Fixing What Hurts: What's Working in Pain Management

1. Six New Genetic Indicators for Rheumatoid Arthritis

Researchers from Brigham and Womenís Hospital (BWH) have uncovered specific locations on chromosomes (loci) linked to rheumatoid arthritis (RA), a progressive autoimmune disease that attacks the joints and other organs. Variations in the genetic sequence at these locations imply a risk of developing RA. A painful and sometimes disabling disease, RA afflicts up to 1 percent of the global population and an average of 2 million people in the United States.

The discovery of a particular location, CD40 — a gene linked to mediating immune and inflammatory responses — is important because CD40 has been a target for therapy in the past. By confirming that genetic variations at this location implies risk of developing RA, researchers have provided a basis for continuing investigation of CD40 to help determine therapy for the disease. In addition to the six loci researchers found, seven other loci have previously been shown to imply risk for RA if variations occur.

"This study supports the idea that there are many more locations on chromosomes that are linked with determining risk of developing this disease," said Robert Plenge, M.D., of the Division of Rheumatology, Immunology and Allergy at BWH. He emphasizes, "Each discovery of a new locus is like finding another puzzle piece that helps us put together a better understanding of RA."

To learn more about this research, please visit:

2. Disease Management Q&A: Pain Management and the PCP

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Marilee I. Donovan, Ph.D., R.N., regional pain management coordinator for Kaiser Permanente Northwest.

Question: How do we educate primary healthcare providers so they feel comfortable dealing with chronic pain and the outcomes are favorable?

Response: (Marilee Donovan) Patience and persistence. About five years ago, medical schools were doing a better job teaching physicians about pain. Our recent survey of physicians as well as one done in southern California indicate that less than two hours of pain management are included in most medical school curriculums. Also, most residents come out of medical school believing that 80 percent of pain patients are addicts that are seeking drugs. Our tools help them understand and assess the patient properly. Then itís easier to trust the patient and do the right thing.

For more details on pain management, please visit:

We want to hear from you! Submit your question for Disease Management Q&A to info@hin.com.

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3. HealthSounds Podcast: Caring for Medicare Patients

Miscommunication during the care transition puts elderly patients at risk for reduced quality of care, poorer outcomes and unnecessary procedures, according to Gregg Lehman, president and CEO of Inspiris. He defines the key players on the care transition team, suggests strategies for improving communications during this crucial phase and describes his organization's approach to dual eligibles who find themselves at this healthcare crossroad.

To listen to this complimentary HIN podcast, please visit:

4. Sinusitis Patients Have Pain Similar to the Elderly and People with Arthritis

A new analysis led by researchers at Georgetown University Medical Center suggests many patients with sinusitis have aches and pains similar in severity to people in their 80s and those with arthritis or depression. The study also finds that endoscopic sinus surgery to clear clogged sinuses can bring significant pain relief.

The purpose of the study was to determine if elevated levels of bodily pain were associated with sinusitis and to examine whether bodily pain improved following endoscopic sinus surgery. In the first known review of its kind, researchers performed a meta-analysis of 11 studies that included a general, health-related quality-of-life survey with a separate assessment of bodily pain before and after endoscopic sinus surgery on a scale of zero (most bodily pain) to 100 (least bodily pain). In addition to their findings about the pervasiveness of pain, a majority of the studies analyzed showed that following endoscopic sinus surgery, postoperative bodily pain scores improved to values similar to that in the general population.

"This study highlights an important point: Chronic sinusitis should not be considered as a minor localized disease condition. Rather, as this study emphasizes, sinusitis can cause serious clinical levels of discomfort in many patients," says Neil Bhattacharyya, M.D., otolaryngologist and sinus surgeon at BWH and Harvard Medical School and the studyís senior author.

To learn more about this research, please visit:

5. Survey of the Month: Healthcare Trends in 2009

A faltering economy, a presidential election and a number of other factors continue to drive changes in the healthcare industry. Want to know how other healthcare organizations are preparing for what the healthcare industry will bring in 2009? Complete HIN's Survey of the Month on Healthcare Trends in 2009 by September 30 and youíll get a free executive summary of the compiled results.

To participate in this survey and receive its results, please visit:

6. Fixing What Hurts: What's Working in Pain Management

Chronic pain can affect an individualís life in more than one way. For instance, pain can wound a patientís wallet at a cost of $500 to $30,000 annually. Pain can also create roadblocks in day-to-day life: Many chronic pain patients lose an average of 4.6 hours per week, which costs employers $61.2 billion annually. To relieve the physical and fiscal suffering associated with pain, many healthcare organizations have implemented pain management programs. To discover how these programs work and who is using them, HIN conducted a non-scientific online survey in April 2008. In response, 186 organizations, including hospitals, nursing homes and health plans, shared their experiences with pain management programs.

To download this complimentary white paper, please visit:
Contact HIN:
Editor: Laura M. Greene, lgreene@hin.com;
Sales & Marketing Coordinator: Deirdre McGuinness, dmcguinness@hin.com;
Publisher: Melanie Matthews, mmatthews@hin.com

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