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October 14, 2010 Volume VII, No. 15

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

According to RAND Corporation researchers, Americans are experiencing a higher rate of diabetes than the English. Learn more about this finding in this week's issue, along with why some Parkinson's patients die sooner than others. And find out how IT is being used in two different ways for preventive care.

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

This week's DM news:

Table of Contents

  1. American Waist Sizes & Diabetes
  2. Parkinson’s Disease Mortality
  3. 2011 Healthcare Trends
  4. Text Messaging Interventions
  5. Co-Located Case Managers
  6. Obesity, Weight Management Benchmarks
  7. Web-Based Prevention
  8. Healthcare Trends for 2011

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Larger Waist Size Linked to Higher Diabetes Rates Among Americans

A higher rate of diabetes seen among adult Americans when compared to peers in England is explained primarily by a larger waist size rather than conventional risk factors such as obesity, according to a new study by researchers from the RAND Corporation, University College London and the Institute for Fiscal Studies in London. Researchers say the findings offer more evidence that accumulating fat around the mid-section poses a health risk and suggests that studies of diabetes risk should emphasize waist size along with traditional risk factors.

Researchers say that Americans middle-aged and older are significantly more likely to suffer from diabetes compared to their peers in England despite a similar standard of living. About 16 percent of American men report having diabetes as compared to 11 percent of English men. About 14 percent of American women have diabetes, compared to 7 percent among English women. An earlier study demonstrated that middle-aged Americans are less healthy than their English counterparts, although medical spending in the United States is more than twice as high as it is in the United Kingdom.

Analyzing studies about the health and lifestyles of large numbers of people from the United States and England, researchers found no association between higher diabetes rates in the United States based upon conventional risk factors such as age, smoking, socio-economic status or BMI. The conventional risk factors for diabetes were similar among both the American and English populations. Americans had slightly higher scores on BMI and were a little older. The English were less educated and more likely to have smoked.

American men had waists that averaged 3 centimeters larger than their English peers and the waists of American women were 5 centimeters bigger than English women. American women were significantly more likely to face higher risk because of their waist size when compared to English women (69 percent to 56 percent), while American men had only a slightly higher waist risk than their English peers. The higher waist size of Americans posed more risk compared to their English peers across most BMI categories. For example, among women with normal weight, 41 percent of American women were categorized as having high waist risk compared to 9 percent of English women.

The study concludes that waist circumference explains a substantial proportion of the higher diabetes rate in America for men and virtually all the higher rate seen among women. Researchers say there may be many reasons why Americans have larger waists than their English peers. It may be caused by different rates of physical activities through exercise or daily activities, diet differences or perhaps other social and environmental factors such as stress that occur in the United States. Researchers say that future research needs to address the different mechanisms that may be responsible for this association. For example, there is evidence that fat in the midsection has a different metabolism than fat carried elsewhere on the torso. Researchers say that past evidence has shown that waist circumference is a better marker for visceral fat than other measurements. Previous studies have shown that fat cells located in a person's midsection have specific dysfunction that may be involved in the mechanisms that lead to diabetes.

To learn more about this research, please visit:

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New Clues on Why Some People with Parkinson's Die Sooner

New research shows that how old people are when they first develop Parkinson’s disease is one of many clues in how long they’ll survive with the disease. The research is published in an October issue of Neurology®, the medical journal of the American Academy of Neurology.

The 12-year study included 230 people with Parkinson’s disease, of whom 211 died by the end of the research. “Remarkably, time to death for these people took anywhere from two to 37 years from diagnosis so it’s important we try to identify those risk factors that lead to an early death so we can find ways to increase a person’s life expectancy,” said Elin Bjelland Forsaa, MD, with Stavanger University Hospital in Norway and a member of the American Academy of Neurology. The average time from the appearance of movement problems to death was 16 years. The average age at death was 81.

The study found that the risk of earlier death was increased about 1.4 times for every 10-year increase in age when symptoms began. People with psychotic symptoms, such as delusions and hallucinations, were also 1.5 times more likely to die sooner compared to those without these symptoms. The odds of dying earlier were nearly two times higher for people who had symptoms of dementia in the study compared to those without memory problems. In addition, men were 1.6 times more likely to die earlier from the disease compared to women. Participants who scored worst on movement tests also had a higher risk of earlier death compared to those with the highest scores. The study also found that taking antipsychotic drugs or drugs for Parkinson’s disease had no negative effect on survival. “Our findings suggest that treatments to prevent or delay the progression of movement problems, psychosis and dementia in people with Parkinson’s disease could help people live longer,” said Dr. Forsaa.

To learn more about this research, please visit:

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Healthcare Trends in 2011 — A Strategic Industry Forecast

Healthcare reform offers two major opportunities for healthcare to bend the spend curve and improve profitability, says Steven Valentine, president of The Camden Group. Valentine also weighs in on the current state of healthcare, and why organizations can't think about healthcare reform without considering the current economy.

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Text Messaging Interventions

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Randall Williams, M.D., F.A.C.C., chief executive officer with Pharos Innovations.

Question: What are some successful text messaging techniques or interventions used by other health plans? Does this work best for notifications about refills, for example, or can text messaging work for preventive health reminders as well?

Response: Text messaging is a great vehicle if that’s how a particular member or patient would like to communicate. The challenge is that many individuals in older demographics — where chronic disease is more prevalent — are not facile in text messaging. Opportunities will continue to evolve as technology evolves and as our population — who has grown up with that technology and it is part of their day-to-day life — continue to age into the categories where more of these chronic conditions are prevalent. But since the target of our interventions have been around chronic disease, few individuals are opting to receive reminders or communication at this point via text.

For more information on IT and preventive health, please visit:

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Co-Located Case Managers

The medical home care team provides patient-centered, coordinated and high-quality care for its members and a growing number of healthcare companies include case managers in their medical home staff. We wanted to see how many organizations have embedded a case manager in their physician practice.

Click here to view the chart.

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2010 Benchmarks in Obesity and Weight Management

This white paper captures the top strategies organizations are implementing to prevent and reduce obesity and related conditions and costs, based on responses from 131 healthcare organizations to the April 2010 Healthcare Intelligence Network Obesity and Weight Management e-survey.

To download this complimentary white paper, please visit:

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Innovative Web-Based Tool Helps Physicians Provide Preventive Care

A Web-based tool that extracts information from the electronic medical record (EMR) helps primary care physicians (PCPs) improve care and manage their entire panel of patients. Those are the findings of two new Kaiser Permanente studies — the first to examine the effectiveness of a population care tool in a large, diverse patient population. The first study, published in The American Journal of Managed Care, found that the proprietary Panel Support Tool (PST) helped doctors improve care for patients with diabetes and/or heart disease. The other study, whose findings appeared in Population Health Management, found that the PST also helped doctors provide better preventive care for healthy patients.

The PST, devised and implemented by doctors at Kaiser Permanente, is a Web-based tool that helps PCPs manage care for individual patients, groups of patients or their entire panel. It does this by comparing the care the patient is receiving to the care that is recommended by national guidelines. For example, doctors can query the PST in advance of a patient visit to find out if that patient needs a screening test or vaccine. They can ask the PST to display a list of all of their patients who are overdue for a mammogram or colon cancer screening test, a list of their diabetic patients whose blood sugar levels are too high or those who need a foot or eye exam.

The first study followed 204 primary care teams who were using the PST to manage care for 48,344 patients with diabetes and/or heart disease. After three years, for patients with diabetes, the percentage of care recommendations met every month increased from 67.9 to 72.6 percent; for heart disease patients, the percentage rose from 63.5 to 70.6 percent. The study used 2005 as the pre-intervention, 2006 as the implementation and 2007 as the post-intervention periods. Care recommendations measured included blood sugar levels, blood pressure screening and control, retinopathy, nephropathy, foot screening, use of aspirin, statins, angiotensin converting enzyme inhibitors and beta blockers, and influenza and pneumococcal vaccination.

The second study involved 207 primary care teams that were using the PST to manage the care of 263,509 adult patients, some whom were relatively healthy and others who have chronic diseases. The study looked at 13 different care recommendations and found that after 20 months, the PST improved performance from 72.9 percent to an average of 80 percent. Researchers found that during the first year of tool use, performance in delivering the care recommendations improved to a statistically significant degree every four months. This study found that the best ways to improve care using PST include querying the system for care gaps for the entire panel every two to four weeks; sending standardized letters or secure e-mail messages around the time of members’ birthdays that identify all needed care; having medical assistants or nurses call patients to schedule screening tests; and having pharmacists review patients’ records for needed care when refilling medications. While the PST is a great tool to help physicians take better care of their patients, it does not override shared decision-making between doctor and patient. More research is necessary to optimize results and determine if patient outcomes improve with improved care delivery.

The PST is a Web-based application that is tightly integrated with Kaiser Permanente HealthConnect®, the world’s largest private-sector EHR. Providers can toggle between the PST and KP HealthConnect, which includes comprehensive documentation of patient care in all settings including the lab, pharmacy, radiology and other ancillary systems. The PST monitors recommendations pertaining to medication management and screening for comorbidities in six chronic conditions: asthma, diabetes, coronary artery disease, heart failure, hypertension and chronic kidney disease. The tool also monitors preventive care measures, such as administering adult immunizations and screening for breast, cervical and colorectal cancer, hyperlipidemia and osteoporosis. For each care recommendation, the PST indicates what actions need to be taken, if any. Once a day the PST extracts data from KP HealthConnect and other data repositories and automatically updates all patient-level and panel views. When patients obtain needed screening or lab tests or fill prescriptions, the panel support tool reflects that activity the following day.

Most recommendations monitored by the tool are derived from the Healthcare Effectiveness Data and Information Set (HEDIS), a tool developed by the National Committee for Quality Assurance and used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service. Other recommendations reflect organizational priorities based on peer-reviewed literature and/or internal research at Kaiser Permanente.

To learn more about this research, please visit:

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Healthcare Trends for 2011

Following this year's passage of the Patient Protection and Affordable Care Act, the real work of healthcare reform has begun. To learn how fellow healthcare companies are preparing for 2011, complete HIN's sixth annual survey on Healthcare Trends in 2011 by October 31. You'll receive a free executive summary of the compiled results, and your responses will be kept strictly confidential.

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

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