Disease Management Update
Volume V, No. 27
October 30, 2008

Dear Healthcare Intelligence Network Client,

The term 'comorbidities' is defined as the presence of one or more disorders or diseases, but rarely do we associate it with one or more mental diseases. But maybe we should. Mental health is getting more national play evidenced by the mandate for mental healthcare parity signed by President Bush earlier this month. This week's DM Update highlights emerging issues in this area: One study links COPD patients with greater risks of depression, and a care management thought leader notes that a large portion of chronically ill patients in the Medicaid population also suffer from depression and schizophrenia.

Also, don't miss your last chance to take HIN's monthly survey on depression and DM by October 31, and receive a free executive summary of results compiled from more than 200 healthcare organizations.

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. Depression Linked to Increased Exacerbations, Hospitalizations in COPD Patients
  2. Disease Management Q&A: How-to’s of Home Visits
  3. HealthSounds Podcast: Managing Comorbidities in DM
  4. HF Linked to Bone Fractures
  5. Survey of the Month: Depression and DM in 2008
  6. Obesity & Weight Management: Weighing in on the Growing Epidemic

1. Depression Linked to Increased Exacerbations, Hospitalizations in COPD Patients

According to new research, depression and anxiety may actually cause increased hospitalizations and exacerbations in COPD patients. Researchers assessed nearly 500 patients with stable COPD for anxiety and depression as well as disease severity. They were contacted monthly by telephone for one year to determine whether they had experienced any exacerbations or hospitalizations.

Depressed patients had a higher proportion of concurrent anxiety than non-depressed patients. They also had higher mortality, more symptom- and event-based exacerbations and hospitalizations and longer hospital stays than non-depressed patients. They were also more likely to have had past exacerbations and hospitalizations. Hospital stays were nearly two and a half times as long for depressed patients, although the association did not reach statistical significance. Anxiety was also associated with a greater risk of exacerbations and longer hospital stays. Overall, among patients with anxiety who had at least one exacerbation, the exacerbation lasted nearly twice as long as those without anxiety, but there was no support for previous findings that hospitalizations were affected by anxiety in length or frequency.

The researchers proposed a number of possible explanations for their findings — that depression itself may effect changes in the immune system; that depression affects patients’ ability to adapt to chronic symptoms, thereby making them more likely to make frequent visits to the doctor and receive pharmacological treatment; or depression may decrease self-confidence and increase feelings of hopelessness, resulting in poorer self-care and poorer medication compliance. In conclusion, this study suggested a possible causal relationship between depression and the risk of COPD exacerbation and hospitalization. Thus, better detection and treatment of depression in patients with COPD may result in improved clinical outcomes and health resource utilization.

“The results of this study can guide researchers and clinicians to evaluate in COPD patients with depression the effectiveness of antidepressants and psychotherapies on reducing exacerbations and related complications such as hospital admissions,” concluded Dr. Bourbeau.

To learn more about this research, please visit:

2. Disease Management Q&A: How-to’s of Home Visits

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Michelle Gilbert, education coordinator of the heart failure team and pulmonary hypertension program at Hackensack University Medical Center.

Question: What are the components and goals of the home visits conducted by the heart failure team?

Answer: (Michele Gilbert) We have spent a lot of time teaching our home care nurses to be astute observers. One thing the nurse will do is interview the patient regarding their health practices and understanding of the disease. We give patients basic educational information. When the nurse conducts the visit, she does a complete physical assessment, as well as an assessment of the patient’s functional abilities. We use the Minnesota Living With Heart Failure Questionnaire, which addresses functional status for the patient. We use that at the first and last visits to ensure that the patient’s functional status and ability to self-manage is improving. We find out what the patient has been eating and what they’re doing. We get our baseline.

On subsequent visits, the nurse might empty the patient’s pantry and show them how much sodium they’ve been eating. They ensure the patient understands where to find hidden sources of sodium. The nurse continues to assess the patient’s progress. They will provide them with a daily system for weighing themselves and recording their weight. The patient’s ability to self-medicate is also assessed. If they don’t have a system for taking their medications, we provide one, such as a seven-day pillbox with four compartments.

For more details on managing heart failure patients, please visit:

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3. HealthSounds Podcast: Managing Comorbidities in DM

On the Medicaid side, McKesson Health Solutions has found that a large portion of the chronically ill beneficiaries also suffer from depression and schizophrenia, says Jim Hardy, senior vice president of care management services. Increasingly, McKesson seeks nurses with a background in behavioral healthcare to provide disease and case management to this population, especially during hospitalizations and at discharge. He describes the challenges inherent in navigating the medical and mental health systems needed by these clients and suggests ways to bridge behavioral healthcare gaps.

To listen to this complimentary HIN podcast, please visit:

4. HF Linked to Bone Fractures

According to a new study, ED patients who are newly diagnosed with heart failure (HF) are at least four times as likely to suffer serious bone fractures over the next year compared with ED patients with other cardiovascular (CV) disorders, suggests a study based on hospital data from more than 16,000 patients. Data from 2,041 patients with a first diagnosis of heart failure and 14,253 patients with other CV disease treated at EDs over a three-year period was analyzed.

Hospitalization rates for any orthopedic bone fracture within a year of the index ED visit were 4.6 percent for the HF patients and 1 percent for non-HF patients. Specifically, hospitalization rates for hip fractures were 1.3 percent for HF patients and 0.1 percent for non-HF patients.

"The main public health message is that in addition to the risks heart-failure patients already have, here is another burden they could potentially face," primary author Dr. Justin A Ezekowitz, University of Alberta, Edmonton. According to Dr. Ezekowitz, "[Providers should see heart failure] as another red flag that the person needs to be screened [for osteoporosis] and treated appropriately." The study concluded that HF is associated with an increased risk of subsequent orthopedic fracture, particularly hip fracture. This suggests that screening for and treatment of osteoporosis to reduce fracture risk need to be considered in those with HF.

To learn more about this research, please visit:

5. Survey of the Month: Depression and DM in 2008

Depression affects over 20 million Americans and billions of dollars are spent on treatment, medication and other therapies. Most cases of depression are still unrecognized or treated inappropriately, which leads to immeasurable costs in employee absenteeism, lost productivity and spiraling healthcare costs. Complete HIN's survey of the month on depression in DM programs in 2008 by October 31 and get a FREE executive summary of the compiled results.

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

6. Obesity & Weight Management: Weighing in on the Growing Epidemic

Increasingly, healthcare organizations are creating initiatives aimed at the 67 million obese and 85 million overweight Americans. In an August 2008 e-survey, nearly 300 healthcare professionals told HIN how they are managing — and working to prevent — this growing problem.

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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