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November 4, 2010 Volume VII, No. 18

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

This week's issue targets obesity and its effects on children. Can hyperactive behaviors in childhood trigger adulthood obesity, and did a "stealth" obesity prevention program benefit low-income, African-American children? Also this week, find out which hospital patients are at a higher risk for cognitive impairment.

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

This week's DM news:

Table of Contents

  1. Hyperactivity & Obesity
  2. Sepsis & Cognitive, Physical Decline
  3. Health Plan Rate Setting
  4. Identifying Members for Case Management
  5. Who's Eligible to Take An HRA?
  6. 2010 Obesity Benchmarks
  7. Hip Hop, Home Visits & Obesity Prevention
  8. Tobacco Cessation and Prevention Programs

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Hyperactive, Impulsive Behaviors in Childhood Could Trigger Adulthood Obesity

The symptoms of attention-deficit/hyperactivity disorder (ADHD) present in childhood are associated with an increased risk of being obese as an adult, and the greater the symptoms, the greater the risk, according to a study by Duke University Medical Center researchers. The population study examined symptoms of inattention, hyperactivity and impulsivity along with BMI, waist circumference and blood pressure among 15,197 adolescents from the National Longitudinal Study of Adolescent Health. The adolescents were followed from 1995 through 2009.

The results show that having three or more of any of the symptoms studied significantly increased the odds of being obese. Among children with only hyperactive or impulsive symptoms, the odds of being obese increased to 63 percent and hyperactive or impulsive symptoms led to greater weight gain in the transition from adolescence to adulthood, making these ADHD symptoms the most significant risk factor studied. The broader implication, according to researchers, is that research like this may offer clues to what's driving the obesity epidemic. "The findings support the idea that certain self-regulation capacities, like the ability to regulate one's impulses, could be a relevant trait to understanding why some people may be more vulnerable to obesity," researchers explained.

The researchers also studied the association between ADHD symptoms and high blood pressure, but concluded that while there was a link, it was related more to the adolescents' weight than their ADHD symptoms. "This research gives us a thread to follow in determining why kids with ADHD symptoms might be at risk for developing obesity. It establishes the path for identifying these kids earlier and focusing on intervention methods," said researchers.

To learn more about this research, please visit:

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Severe Sepsis Associated with Later Cognitive, Physical Decline

Older adults who survive hospitalization involving severe sepsis, a serious medical condition caused by an overwhelming immune response to severe infection, are at higher risk for cognitive impairment and physical limitations than older adults hospitalized for other reasons, researchers have found. In sepsis, immune system chemicals released into the blood to combat serious infection trigger widespread inflammation. This can lead to low blood pressure, heart weakness and organ failure. Anyone can get sepsis, but infants, children, older people and those with weakened immune systems are most vulnerable. People with sepsis often receive treatment in hospital ICUs to combat the infection, support vital organs and prevent a drop in blood pressure.

Using data from the NIA-supported Health and Retirement Study (HRS), the researchers analyzed the cognitive and physical function of older people before and after hospitalization for severe sepsis. The HRS is a long-term study that collects information on the health, economic and social factors influencing the health and well-being of a nationally representative sample of Americans over age 50. Study data on participants 65 and older are linked to Medicare claims data to enable detailed analysis of medical conditions and health status. The scientists analyzed Medicare claims data from 516 people who survived 623 hospitalizations for severe sepsis between 1998 and 2005. The average age of participants was 77 at the time of hospitalization. The researchers also examined the individuals’ HRS data on cognitive function, measured through standard tests. Physical limitations were measured by the need for assistance in six activities of daily living basic self-care tasks (walking, dressing, bathing, eating and getting into and out of bed) and five instrumental activities of daily living (preparing a hot meal, shopping for groceries, making telephone calls, taking medicines and managing money), which are associated with the ability to live independently. For comparison, the researchers analyzed Medicare and HRS data on 4,517 survivors of 5,574 non-sepsis general hospitalizations during this time period.

Researchers found that an older person’s risk of cognitive decline increased almost threefold following hospitalization for severe sepsis. They also found that severe sepsis was associated with greater risk for the development of at least one new limitation in performing daily activities following hospitalization. "Sepsis is common in older people and has a high mortality rate," said NIA Director Richard J. Hodes, M.D. "This study shows that surviving sepsis may bring substantial and under-recognized problems with major implications for patients, families and the healthcare system."

Almost 60 percent of hospitalizations for severe sepsis were associated with worsened cognitive and/or physical function among survivors in the first survey following hospitalization. The risk of progression to moderate or severe cognitive impairment in sepsis survivors was 3.33 times higher than their risk before hospitalization. Severe sepsis was associated with the development of 1.57 new functional limitations among patients with no limitations before sepsis. In contrast, patients who did not develop sepsis and had no functional limitations before hospitalization developed an average of 0.48 new functional limitations. Non-sepsis hospital admissions were not associated with an increased risk for cognitive decline.

To learn more about this research, please visit:

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Health Plan Rate Setting — Balancing Premium Increases Against Regulatory Oversight

John Steele
John Steele
Steve Young
Steve Young
In an atmosphere of increased state and federal oversight of health plan rates, healthcare organizations need a sound strategy for determining premium rate increases that meet regulatory approval. HealthScape Advisors managing directors Steve Young and John Steele describe the challenges of setting rates in this environment and the essential experience that can best prepare health plans for dealing with commercial plans.

To listen to this complimentary HIN podcast, please visit:

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Identifying Members for Case Management

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is James Hardy, senior vice president of care management services at McKesson Health Solutions.

Question: How are members identified for a primary care case management (PCCM) program and what methodology, if any, is utilized to assign a risk status to individuals with multiple comorbidities? Are members with multiple comorbidities assigned a risk status for more than one DM program?

Response: In the enhanced PCCM programs in Illinois and Pennsylvania, for example, there is mandatory enrollment of the consumers. They are required to participate in the selection of a PCP and there’s no screening of that in those programs. We use a variety of tools to get at that risk score. It is a cumulative tool that we use primarily inside the business that accumulates the risk score across disease. You will get a higher risk score with a comorbid condition than with a single condition. It’s a proprietary tool, but there are plenty of other tools that are out there that are useful in assigning and predicting risk. Johns Hopkins has a good product, and many of the Medicaid agencies also use Chronic Illness and Disability Payment System (CDPS), which was developed by Richard Kronick, Ph.D., at the University of California at San Diego.

For more information on comorbidity care models, please visit:

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Who's Eligible to Take An HRA?

Aggregate data from health risk assessments (HRAs) guides healthcare organizations in the development and delivery of health promotion and disease management interventions. We wanted to see who is eligible to take an HRA.

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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Program for Low-income, African-American Kids Shows Promise in Obesity Prevention

An approach that attempted to prevent childhood obesity in African-American girls produced beneficial changes in cholesterol, diabetes risk and depressive symptoms but had little effect on youths’ weight, in a trial conducted by researchers at the Stanford University School of Medicine and Lucile Packard Children's Hospital.

Although researchers had hoped to see a change in BMI across the entire study population from the program — culturally tailored dance classes and screen time reduction for African-American girls in low-income neighborhoods of Oakland, Calif. — they did find statistically significant benefits to weight reduction among two high-risk subgroups of children: girls from single-parent households and those who watched a lot of TV. They also noted that the large-scale, randomized trial produced other important benefits: it lowered participants’ total cholesterol and LDL cholesterol levels, reduced the onset of high insulin levels and reduced symptoms of depression. Researchers said that those results are important signs of progress in the efforts to design health promotion and disease prevention campaigns for populations that are most plagued by obesity and also the most difficult to reach. And they added that the lack of better weight loss results underscore the challenges these programs face. "Low-income African-American girls are one of the groups at highest risk of obesity and its complications, yet very little had ever been done to try to address this group," said the researchers. "Our focus was on intrinsic motivation: trying to identify behaviors kids would enjoy doing for their own sake that also happen to be health promoting."

The researchers tested a two-year program of dance classes for 134 randomly assigned pre-teen African-American girls in Oakland. In addition to learning hip-hop, step and traditional African dancing, participants received home visits to encourage them to watch less TV, an intervention that has previously been shown to reduce obesity. The comparison group consisted of 127 similar girls who received health education classes. Health assessments and measures of such behaviors as TV watching and physical activity were collected regularly during the study. According to researchers, "We designed this intervention to be culturally relevant to the children participating. They were learning about the history of dance and the important contributions traditional African dance has made to contemporary hip-hop dance." The dancers also had several opportunities to perform at community events.

Onset of elevated insulin, or pre-diabetes, was 65 percent lower among the dance and screen-time-reduction girls than the comparison group, and the total cholesterol and LDL cholesterol reductions in the dancers were large enough to translate into substantial reductions in cardiovascular risk, according to the researchers. The smaller-than-expected effect on obesity may have been due in part to challenges faced in the neighborhoods where the study was conducted, said researchers. For instance, attendance at dance classes was hampered by six changes of venue that resulted from changes in community-center leadership and violent crime at or near centers where the classes were held. Dance classes were offered five days per week, and the researchers hoped girls would attend three days each week, but median attendance was less than one class per week.

The next step in the research is to translate the connection between fun and health promotion to many other settings. Researchers are now evaluating a variety of "stealth interventions" for weight gain prevention and control: ways to tap people’s intrinsic motivations to engage in behaviors that also happen to be healthy. For example, they are using interest in climate change and environmental sustainability to encourage people to eat healthier diets.

To learn more about this research, please visit:

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Tobacco Cessation and Prevention Programs

Cigarette smoking continues to be the leading cause of preventable morbidity and mortality in the United States, reports the U.S. Department of Health and Human Services. CDC data indicates that cigarette-smoking related healthcare expenditures in 2008 in the United States totaled nearly $96 million, and that the employer bears a cost of $3,391 per smoking employee per year, including $1,760 in lost productivity and $1,623 in excess medical expenditures. What is your organization doing in the areas of tobacco cessation and prevention? Complete HIN's Survey of the Month on tobacco cessation and prevention by November 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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