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January 7, 2010 Volume VI, No. 32

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

According to the World Health Organization, as of the end of 2009, rates of hospitalization in North America for H1N1 among cases aged 5-17 years and 18-49 years far exceeded rates observed during recent influenza seasons, while rates of hospitalizations among cases aged >65 years were far lower. In this issue of the DM Update, learn how age, symptoms and other factors affect the transmission of the flu, how H1N1 affects children with sickle cell disease, and whether school closures are an effective way to control influenza epidemics.

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

This week's DM news:

Table of Contents

  1. Children Catching Swine Flu
  2. H1N1 and Children with Sickle Cell
  3. Medication Therapy Management
  4. Maintaining a Long-Term Coaching Relationship
  5. Healthcare Trends: Reducing Hospital Readmissions
  6. Closing School for Flu Epidemics
  7. Medication Adherence

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Children More Likely to Catch Swine Flu

Young people under 18 years old are more likely than adults to catch swine flu from an infected person in their household, according to a new study published in The New England Journal of Medicine. However, the research also shows that young people are no more likely than adults to infect others with the pandemic H1N1 virus. In the study, researchers analysed data collected by the CDC from 216 people believed to be infected with the swine flu virus, or 2009 H1N1, and 600 people living in their households, to determine how age, symptoms, number of people in a household and length of time after symptoms are first reported affect how easily people transmit the virus to one another.

The data reveal that household contacts aged 18 or under were twice as likely to be infected by a patient in their household, compared to adults aged 19 to 50. Household members aged over 50 were the least susceptible to infection. However, this study shows that the age of a patient did not appear to affect their risk of passing on infection, despite suspicions that children may be more infectious than adults.

The study also suggests that it may be unnecessary for patients to stay at home for longer than four days after they start to have symptoms. It reveals that the average length of time between one person displaying the first symptoms of flu and someone else in their household having symptoms is 2.6 days. At the start of the current pandemic, the CDC advised patients to stay at home for seven days, but it has since revised these guidelines to 24 hours after the end of fever (without the use of fever-reducing medications), which is supported by the new research findings.

Most transmissions occur shortly before or after the first patient shows symptoms of infection, according to the study. The risk of someone catching the virus is higher in households of only two people compared to households of six people: 28 percent of household contacts developed acute respiratory illness in households of two people, compared to 9 percent in households of six people. The authors of the study believe this is because in larger households there is less one-on-one contact between family members. The study shows that no particular symptoms, including cough, runny nose, fever, sore throat, vomiting and diarrhea, were more associated with the virus being transmitted between people in the same household than the others. However, for some of the symptoms, there was little power to detect an effect since, for example, almost all patients (92 percent) had a cough.

To learn more about this research, please visit:
http://www3.imperial.ac.uk/newsandeventspggrp/...

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H1N1 More Risky Than Seasonal Flu in Children with Sickle Cell Disease

Infection with the H1N1 virus, or swine flu, causes more life-threatening complications than seasonal flu in children with sickle cell disease, according to research from Johns Hopkins Children’s Center. The findings warn parents and caregivers that such children are more likely to need emergency treatment and stays in an ICU. The researchers analyzed the records of 118 children with sickle cell disease treated for any kind of flu at Hopkins Children’s between September 1993 and November 2009. Of them, 28 were infected with the H1N1 virus, a new strain that emerged for the first time in April 2009.

While both the seasonal flu and the H1N1 virus caused similar general symptoms like fever, cough and a runny nose in most of the children, sickle cell patients infected with H1N1 were three times more likely to develop acute chest syndrome, a leading cause of death among these patients, marked by inflammation of the lungs, reduced oxygen capacity and shortness of breath. H1N1-infected children were five times more likely to end up in the ICU, and were overall more likely to end up on a ventilator and more likely to need a blood transfusion than those with seasonal flu. Another Hopkins Children’s study released earlier in 2009 found that children with sickle cell disease are hospitalized with seasonal flu nearly 80 times more often than other children.

The researchers say their findings point to the need to include children with sickle cell disease in the list of those who must be immunized against all flu strains, which already includes children with asthma, diabetes, heart disease and other chronic conditions

To learn more about this research, please visit:
http://www.hopkinschildrens.org/H1N1-Risky-for-Kids...

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Medication Therapy Management in the Patient-Centered Medical Home

The pharmacist has a natural and important role in patient medication reconciliation and review, explains Dr. Beth Chester, senior director of clinical pharmacy services and quality, Kaiser Permanente Colorado. She describes the dramatic impact that a pilot pharmacist intervention had on emergency department visits and mortality rates among patients just discharged from skilled nursing facilities (SNFs) once the health plan's pharmacists stepped in to monitor medication therapy in this population.

To listen to this complimentary HIN podcast, please visit:
http://www.hin.com/podcasts/podcast.htm#108

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Maintaining a Long-Term Coaching Relationship

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Susan Butterworth, Ph.D., director of health management services at Oregon Health & Science University.

Question: How can health coaches be more effective and have continuous engagement with their members so that they see the importance of health improvement over time?

Response: There are a couple of different levels where I emphasize, “First, do no harm.” You have to establish that rapport and not raise resistance. It sounds like they’re doing a great job of that in terms of being able to connect with the person in a vulnerable state. They’re establishing the rapport and they are able to get the person’s attention. But there is another important variable here where we truly go into the art and science of the behavior change. We have to help the person move through the stages of change, not only feeling supported but being able to do things. For example, look at their self-efficacy and their ambivalence. Be able to elicit change talk. Encourage him or her to try to go one level further in terms of the sophistication of their health coaching. Also, look at the type of health coaching that is going to encourage a shift in the behavior change process. Once the rapport and the support is there, then they can move further, because the individual is going to be engaged in the process beyond that point of feeling susceptible.

For more information on health coaching effectiveness and engagement, please visit:
http://store.hin.com/product.asp?itemid=3841

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

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Healthcare Trends & Studies: Reducing Hospital Readmissions

With public and private payors sharpening their focus on and realigning reimbursement with hospital readmission rates, particularly among Medicare patients with heart attack, heart failure and pneumonia, more healthcare organizations are taking a hard look at readmission rates and launching programs to reduce these rates. This white paper summarizes the responses of 107 healthcare organizations to HIN's November 2009 Reducing Hospital Readmissions e-survey, which set out to identify the rudiments of readmission reduction efforts in the healthcare industry, from target populations and conditions to responsibilities, roles and ROI.

To download this complimentary white paper, please visit:
http://www.hin.com/library/registerrhr.html

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Short-Term School Closures Ineffective for Controlling Influenza Epidemics

Closing schools for less than two weeks during an influenza epidemic has no effect on infection rates, according to a study by researchers at the University of Pittsburgh, RTI International and the Allegheny County Health Department.

According to study authors, short-duration school closures may actually increase infection rates by returning susceptible students back to school in the middle of an epidemic when they are most vulnerable to infection. The study also found that identifying sick students individually and keeping them from attending school had minimal impact on an epidemic. In addition, there were no significant differences between individual school closures and system-wide closures in mitigating an epidemic.

The study was developed from a series of computer simulations that characterize influenza transmission in Allegheny County (Pittsburgh) Pennsylvania. The findings indicate that schools may need to be closed for at least eight weeks in order to significantly reduce the spread of infection.

Closing schools has been used as strategy to stem or slow the current H1N1 influenza pandemic. Indeed, hundreds of schools across the country have been closed at different periods during 2009 to prevent the spread of infection. According to study coauthor Philip C. Cooley, assistant director of bioinformatics and a fellow at RTI, "since children are more susceptible to most influenza strains than adults, closing schools seems an obvious strategy to slow the spread of the flu. However, computer simulations indicate that such closures are ineffective unless they are sustained for at least eight weeks after implementation."

To learn more about this research, please visit:
http://www.rti.org/newsroom/news.cfm?nav=821...

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Medication Adherence

Of 1.8 billion prescriptions dispensed annually in the U.S., only 50 percent are taken correctly by the patient, according to the World Health Organization. Beyond increasing risk of death, poor medication adherence is tied to as much as $290 billion annually in increased medical costs and responsible for 33 to 69 percent of all medication-related hospital admissions in the U.S., at a cost of about $100 billion per year. Please share your organization's efforts to improve medication adherence by completing HIN's Survey of the Month by January 31, 2010. You'll 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:
http://www.surveymonkey.com/s/K6MP2BD

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