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October 1, 2009 Volume VI, No. 20

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

In this issue of the Disease Management Update, community-based efforts in smoking cessation — from smoking bans in three parts of the world to disease prevention programs on tobacco use — are improving heart health problems. Because of these community efforts, fewer neighbors are becoming sick from secondhand smoke.

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

This week's DM news:

Table of Contents

  1. Heart Attack Rates & Smoking Bans
  2. Candy, Fruit Flavored Cigarettes Illegal
  3. Evidence-Based Guidelines in Medical Homes
  4. Pre- vs. Post-DM Coaching
  5. Healthcare Trends & Studies
  6. Community Disease Prevention Programs
  7. Healthcare Trends in 2010

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

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Heart Attack Rates Drop After Smoking Bans, Continue Downward Over Time

One year after passing smoking bans, communities in North America and Europe had 17 percent fewer heart attacks compared to communities without smoking restrictions, and the number of heart attacks kept decreasing with time, according to a report in Circulation: Journal of the American Heart Association.

The report is a meta-analysis of 13 studies in which researchers examined changes in heart attack rates after smoking bans were enacted in communities in the United States, Canada and Europe. The researchers found that heart attack rates started to drop immediately following implementation of the law, reaching 17 percent after one year, then continuing to decline over time, with about a 36 percent drop three years after enacting the restrictions.

According to James M. Lightwood, Ph.D., co-author of the study and assistant adjunct professor in the department of clinical pharmacy at the University of California-San Francisco, the community effect is consistent with probable individual risk and exposure scenarios. For example, according to the American Heart Association’s Heart Disease and Stroke Statistics 2009 Update, non-smokers exposed to secondhand smoke at home or at work have a 25 percent to 30 percent increased risk of developing heart disease. This new research suggests that the individual increased risk may be higher, said Dr. Lightwood.

To learn more about this research, please visit:

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Candy and Fruit Flavored Cigarettes Now Illegal in United States; Step is First Under New Tobacco Law

The U.S. FDA has banned cigarettes with flavors characterizing fruit, candy or clove. The ban, authorized by the new Family Smoking Prevention and Tobacco Control Act, is part of a national effort by the FDA to reduce smoking in America. Smoking is the leading preventable cause of death in America. The FDA's ban on candy and fruit-flavored cigarettes highlights the importance of reducing the number of children who start to smoke, and who become addicted to dangerous tobacco products. The FDA is also examining options for regulating both menthol cigarettes and flavored tobacco products other than cigarettes.

Flavors make cigarettes and other tobacco products more appealing to youth. Studies have shown that 17-year-old smokers are three times as likely to use flavored cigarettes as smokers over the age of 25. According to FDA Commissioner Margaret A. Hamburg, M.D., "almost 90 percent of adult smokers start smoking as teenagers. These flavored cigarettes are a gateway for many children and young adults to become regular smokers. The FDA will utilize regulatory authority to reduce the burden of illness and death caused by tobacco products to enhance our Nation's public health."

The FDA is taking several steps to enforce the ban. A letter recently sent to the tobacco industry provided information about the law and explained that any company who continues to make, ship or sell such products may be subject to FDA enforcement actions. The FDA has also made available an advisory to parents on the risks associated with flavored tobacco products.

To learn more about this research, please visit:

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Applying Evidence-Based Guidelines in the Medical Home

Despite the challenges, cost and uncertain return of EHRs, practices should move quickly to adopt this tool, recommends Dr. Richard J. Baron, president and CEO of Greenhouse Internists, where the EHR is the backbone that supports the implementation of evidence-based practices.

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Pre- vs. Post-DM Coaching

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Ted Borgstadt, chairman and founder of TrestleTree, Inc.

Question: Is ROI generally greater on health coaching to manage chronic illness or on coaching individuals to change pre-disease behaviors such as smoking or obesity?

Response: Conventional wisdom 10 years ago overwhelmingly would say that DM would give a larger and more immediate ROI. There are more people at risk today and companies that will be spending money. Their ROI is not just focused on those that already have chronic disease and looking at that 1 percent or 2 percent. If you can just impact them, you can impact the overall trend of an organization. Because of the vast majority of the people at risk, you’re seeing more people focusing on the pre-disease state and showing true measurable ROI.

For example, one of our clients has a large trucking company. In compliance with the Department of Transportation regulations, if you have diabetes and take insulin or if your blood pressure is above a certain range, you cannot drive a truck. The average BMI of truck drivers is over 31, and half of them smoke. A three-year study showed over a 2:1 ROI, and most of the individuals involved in the program were pre-diseased. They may be very obese or they may smoke, but they don’t have a chronic condition. The sickest of the sick were not part of this population and yet still showed an ROI. Twenty-five percent of the preventable accidents were averted for participants in our coaching program versus those that were not participating.

It makes sense — if you’re getting people to exercise, they’re more alert, they’re losing weight and they’re stopping smoking. There’s going to be fewer preventable accidents occurring, and that’s part of the ROI measure. In that situation, we focused on the broad population with the pre-disease and still showed a solid ROI.

For more information on evaluating health and wellness coaching performance, outcomes and ROI, please visit:

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Non-Compliant No More — Health Coaching Moves Focus Upstream to Health Behavior, Motivation and Readiness to Change

Health coaches are at the heart of today's healthcare continuum, reflecting an industry shift from simply targeting chronic conditions to addressing all conditions within the DM spectrum, with an emphasis on wellness and prevention. With data from real-life coaching initiatives, this white paper provides an overview of health coaching, the behavioral theories and training that support it and commentary from organizations that have implemented health coaching to reduce healthcare costs and improve population outcomes.

To download this complimentary white paper, please visit:

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Community Prevention Programs Reduce Disease

Trust for America's Health (TFAH) and The New York Academy of Medicine (NYAM) released a new report featuring a range of evidence-based disease prevention programs that have shown results for improving health and reducing costs in communities.

The "Compendium of Proven Community-Based Prevention Programs" report includes a summary and examples of peer-reviewed studies evaluating the effectiveness of community-based disease prevention programs designed to reduce tobacco use, increase physical activity and/or improve eating habits. NYAM identified 84 articles with evidence showing how community-based prevention programs can directly reduce disease rates or disease progression. The "Compendium" report also includes examples of evidence-based community prevention programs that have helped reduce rates of asthma, falls among the elderly and sexually-transmitted diseases.

One program featured in the report is the Rockford Coronary Health Improvement Project in Rockford, Illinois, a community-based lifestyle intervention program aimed at reducing coronary risk, especially in a high risk group. The intervention included a 40-hour educational curriculum delivered over a 30-day period with clinical and nutritional assessments before and after the educational component, in which participants were instructed to optimize their diet, quit smoking and exercise daily (walking 30 minutes per day). At the end of the 30-day intervention period, stratified analyses of total cholesterol, LDL, triglycerides, blood glucose, blood pressure and weight showed highly significant reductions with the greatest improvements among those at highest risk.

To learn more about this research, please visit:

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Healthcare Trends in 2010

Healthcare reform, a fragile economy, high numbers of uninsured, the lingering threat of H1N1and emerging care models are just a few factors that promise to drive changes in the healthcare industry in the coming year. To learn how other healthcare organizations are preparing for 2010, complete HIN's fifth annual survey on Healthcare Trends in 2010 by October 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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