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October 15, 2009 Volume VI, No. 22

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

In this issue, you will discover the link between physical activity and brain cancer and the relationship between pathological complete response rates and race in women with breast cancer. On the H1N1 front, the CDC and pharmacists are working together to promote appropriate antibiotic use during this flu season.

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

This week's DM news:

Table of Contents

  1. Physical Activity in Adolescence and Brain Cancer
  2. Relationship Between PCR Rate, Race in Breast Cancer
  3. NCQA Medical Home Recognition
  4. Motivational Interviewing in Behavior Change
  5. Healthcare Trends & Studies
  6. Appropriate Antibiotic Use
  7. Healthcare Trends in 2010

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Physical Activity in Adolescence Associated with Decreased Risk of Brain Cancer in Adulthood

Researchers at the National Cancer Institute have found that glioma, a rare but often deadly form of brain cancer, may be linked to early life physical activity and height. Gliomas are the most common type of brain cancer, accounting for nearly 80 percent of brain and central nervous system cancers. Though little is known about the causes of glioma, some evidence suggests that early life exposures may play a role in disease etiology. Because the brain develops rapidly during childhood and adolescence, it may be more susceptible to environmental influences during this time.

The researchers examined whether markers of early life energy expenditure and intake (physical activity, BMI and height) are related to glioma risk. Between 1995 and 1996, researchers distributed a baseline questionnaire about dietary intake and other lifestyle exposures to participants in the National Institutes of Health-AARP Diet and Health Study. Nearly 500,000 men and women answered questions about physical activity, body weight and height. The researchers then followed study participants for eight years, during which time 480 glioma cases occurred.

Participants who were physically active during adolescence had a decreased risk of glioma; their risk was about 36 percent lower than those who were inactive, according to the study. The researchers also found that those who were obese during adolescence had an increased risk of glioma; their risk was approximately three to four times that of individuals who were normal weight during adolescence. However, the researchers cautioned that "we did not have many people in the study who were obese during adolescence." The researchers additionally confirmed results of previous studies linking height to increased glioma risk; risk among taller participants was twice that of those considered shorter.

To learn more about this research, please visit:

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Study Finds No Relationship Between PCR Rate and Race in Women with Breast Cancer

Locally advanced breast cancer patients who received the same class of neoadjuvant chemotherapy were found to have no evidence of disease at the time of their surgery, or achieved pathological complete response, at the same rate regardless of race, according to researchers at The University of Texas M. D. Anderson Cancer Center. The study, presented in a poster discussion session at the "2009 Breast Cancer Symposium" in San Francisco, is the largest in a homogenous group of breast cancer patients evaluating pathological complete response (PCR) according to race.

The retrospective study identified 2,074 patients diagnosed with stages II and III breast cancer and treated between 1994 and 2008. Of the patients, 1,334 (64.3 percent) were white, 302 (14.6 percent) black, 316 (15.2 percent) Hispanic and 122 (5.9 percent) were classified as "other" race groups. All of the patients received neoadjuvant anthracycline- and taxane-based chemotherapy; receiving similar class of therapy was an important component in the design of the study, said the researchers.

At the time of surgery, the researchers found no difference of statistical significance in PCR rates among racial groups: 12.3 percent in whites, 12.5 percent in blacks, 14.24 percent in Hispanics and 11.5 percent in "other." Among all patients, at a median follow-up of 30 months, there were 438 recurrences and 327 deaths. The five-year unadjusted recurrence-free (RFS) and overall survival (OS) rates were 71 percent and 79 percent in whites, 60 percent and 57 percent in blacks, 76 percent and 79 percent in Hispanics and 75 percent and 84 percent in "other," respectively. Lack of achieving PCR, HER2-positive and triple-negative subtypes, lymph node involvement were all found to be independent predictors of worse RFS and OS.

To learn more about this research, please visit:

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Achieving NCQA's Patient-Centered Medical Home Recognition

Grand Valley Health Plan's (GVHP) workgroup approach helps the staff model HMO to successfully disseminate workflow changes resulting from its NCQA medical home recognition process, explains Barbara Luskin, GVHP quality manager, and also created location champions in the process. Luskin describes how GVHP demonstrates compliance with the most challenging NCQA "must-pass" elements and shares GVHP's early returns in patient satisfaction ratings, quality of care and healthcare utilization.

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Objectives of Motivational Interviewing in Behavior Change and Chronic Illness Management

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Kristin S. Vickers Douglas, Ph.D., L.P., clinical health psychologist and medical director of Mayo Clinicís EmbodyHealth program.

Question: What is the chief objective of motivational interviewing (MI), and how does it differ from a traditional clinical approach to behavior change and managing chronic illness?

Response: A traditional approach often involves sharing information with an individual and advising them to make change. That might be helpful if a person isnít aware of that information. If somebody is at an information deficit, they donít have the right tools to make change because they donít know about the change that they need.

We can think about that with smoking. There was a time when we did not understand fully the health hazards associated with smoking, but now if we talk to patients, the vast majority is fully aware that smoking is dangerous to their health. Information delivery is not enough for these individuals to make change. Smoking is a complex behavior. A lot of things go into the choice to pick up a cigarette — social issues, environmental issues, financial, stress management — cutting across many of the key aspects of their life. To simply deliver information is not sufficient. MI approaches try to partner with the individual and bring to the table their expertise in knowing themselves, their values, their preferences and especially their motivations.

MI is about helping an individual identify where they are in terms of readiness to change and to use helpful strategies to facilitate them moving toward the next step. Especially helpful in MI is the work we do around peopleís ambivalence to change, their resistance to change. We do many things that are unhealthy in our lives but for good reasons. Sometimes we make a choice to run through a [fast food] drive-through and get all the worst things on the menu. We know they are the worst things, but that makes sense for that day. Itís fast. Itís easy. Itís cheap. Itís what we crave. We had a bad day. Weíre stressed. Sometimes there are things that work well about being unhealthy. We canít just tell someone to do all the right things and give them information about doing all the right things. Instead, we have to understand why they struggle with change and understand the pressures and challenges that are unique to that individual that keeps them stuck.

For more information on patient engagement, activation and behavior change in health coaching, please visit:

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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. The Healthcare Intelligence Network conducted a non-scientific online survey to determine what steps healthcare organizations are taking to prevent the infection.

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Pharmacists Join CDC to Promote Appropriate Antibiotic Use

Pharmacists around the nation are joining the CDC to educate consumers about the appropriate use of antibiotics during this influenza season. Antibiotics are intended to treat bacterial infections, not viruses like the flu. The Get Smart: Know When Antibiotics Work program reaches parents, pharmacists and healthcare providers through print advertisements, fact sheets, brochures, posters, radio and print public service announcements, podcasts and mainstream media interviews.

Doctors often feel pressure from patients or parents to prescribe antibiotics, especially during the flu season. According to a recent study published in the Journal of the American Medical Association, 50 percent of people who visit their doctor for upper respiratory infections receive an antibiotic prescription. Antibiotics kill bacteria, not the viruses that cause colds or flu, most coughs and bronchitis, sore throats not caused by strep, and runny noses. Taking antibiotics when you don't need them or not as prescribed increases your risk of getting an infection later that resists antibiotic treatment. Antibiotic overuse is a serious problem and a threat to everyoneís health.

To help prevent illness, the CDC encourages people to wash their hands frequently, use hand sanitizers when hand washing is not feasible, get the flu vaccine and other recommended vaccines and avoid close contact with people who are sick. Also, the CDC recently hosted a first-ever retail pharmacy summit that brought together retail pharmacy chains Rite-Aid, Kroger, Giant Eagle and Giant/Stop and Shop, non-profits and advocacy groups committed to decreasing the spread of antibiotic resistance and strengthening the important role of pharmacists in educating patients on remedies for colds and flu.

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 H1N1 and 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.

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