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November 5, 2009 Volume VI, No. 25

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

According to the National Heart, Lung and Blood Institute, Americans' awareness of COPD is rising. Unfortunately, understanding of COPD is not. Discover more on COPD awareness and treatability as well as the surprising effects of hope on the chronically ill in this week's issue of the DM Update.

You'll also learn about new policy recommendations for improving medication adherence.

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

This week's DM news:

Table of Contents

  1. COPD Awareness
  2. Chronically Ill Might be Happier If They Gave Up Hope
  3. Physician Practice Innovations
  4. Supporting Medication Adherence
  5. Healthcare Trends & Studies
  6. How to Improve Medication Adherence
  7. Reducing Hospital Readmissions

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Melanie Matthews, mmatthews@hin.com

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Awareness of COPD Is Rising, But Understanding Is Still Low

Awareness of COPD continues to grow in the United States, according to national survey results by the National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health. Sixty-eight percent of adults are now aware of COPD, a disease that affects one in five people over age 45, compared with 64 percent last year, and 49 percent in a 2004 survey. Among a high risk group — those who are currently smoking — awareness rose to 74 percent compared to 69 percent a year ago. Less than half of all adults — 44 percent — understand that the disease can be treated.

COPD, which is sometimes referred to as chronic bronchitis or emphysema, is a serious lung disease affecting 24 million men and women in the United States. However, half of them remain undiagnosed despite recognizable symptoms such as shortness of breath while doing activities that used to be easy, wheezing or chronic cough (sometimes called a "smoker’s cough"). Eight out of 10 cases of COPD are due to smoking, typically affecting those over 40. The remaining cases are due to genetics or other environmental exposures. Symptoms of COPD were approximately two times more common among current smokers than former smokers, but current smokers are only half as likely to talk to their doctors about these symptoms. Survey results showed that 41 percent of current smokers do not talk to their doctors about these symptoms because they do not want to hear another quit smoking message.

The survey also showed that physicians maintain an optimistic view about COPD treatability. Approximately nine out of 10 primary care physicians agree that available treatments can optimize quality of life for their patients with COPD. However, the survey also showed that this message may not be familiar to their patients.

To learn more about this research, please visit:

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Research Shows Chronically Ill Might be Happier If They Gave Up Hope

Holding on to hope may not make patients happier as they deal with chronic illness or diseases, according to a new study by University of Michigan (U-M) Health System researchers. The study, which focused on patients who had new colostomies, showed that people do not adapt well to situations if they are believed to be short-term.

At the time they received their colostomy, some patients were told that the colostomy was reversible — that they would undergo a second operation to reconnect their bowels after several months. Others were told that the colostomy was permanent and that they would never have normal bowel function again. The second group — the one without hope — reported being happier over the next six months than those with reversible colostomies.

According to Peter A. Ubel, M.D., director of the U-M Center for Behavioral and Decision Sciences in Medicine, “We think they were happier because they got on with their lives. They realized the cards they were dealt, and recognized that they had no choice but to play with those cards. The other group was waiting for their colostomy to be reversed. They contrasted their current life with the life they hoped to lead, and didn’t make the best of their current situation.” Dr. Ubel also said that health professionals find it easier to deliver optimistic news to patients even when they believe the prognosis is unfavorable, justifying it by assuming that holding on to hope was better for the patient.

To learn more about this research, please visit:

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Physician Practice Innovations To Improve Care Delivery

Medical home innovators Group Health Cooperative, Greenhouse Internists and Grand Valley Health Plan describe practice level transformations that improve care delivery and move them along the path to NCQA medical home recognition in Part 2 of Medical Home Open House Highlights.

To listen to this complimentary HIN podcast, please visit:

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Changing Systems to Support Medication Adherence

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Connie Commander, immediate past president of the Case Management Society of America and president of Commander’s Premier Consulting Corporation.

Question: What systems changes do organizations have to implement to support medication adherence?

Response: Coming from a case management environment, I believe the most important systems change is software, and within the software should be the algorithms. For many reasons, standardized tools are very important. This is because standardized tools will help us to know what each healthcare provider has done. Then we’re able to hand off to the next healthcare provider that’s going to touch that patient. We can’t do that unless we have standardized tools and agreements about what we’re measuring. We then need to have a focused effort by all organizations to educate all of the healthcare team on what we’re shooting for. This is the paradigm shift in how we educate ourselves and our patients.

For more information on medication adherence, please visit:

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2009 Telehealth Benchmarks — Wired for Access and Efficiency

How are healthcare organizations utilizing telehealth and telemedicine? How prevalent is remote monitoring, and which medical conditions are most often monitored? How has telehealth impacted levels of healthcare access, efficiency, cost and patient compliance? The Healthcare Intelligence Network set out to answer these questions and others during its 2009 Telehealth e-survey. This executive summary of responses from 134 healthcare organizations identifies emerging trends in the use of telehealth and telemedicine and offers a glimpse into a healthcare future where no patient is left behind because of a lack of access.

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Experts Offer Policy Recommendations For Improving Medication Adherence

A diverse group of healthcare and consumer organizations and companies released five policy recommendations designed to promote better medication adherence and improved health outcomes for patients. The group, which includes the American College of Cardiology, GlaxoSmithKline, the National Association of Chain Drug Stores, the National Consumers League and the Pharmaceutical Research and Manufacturers of America, focused their recommendations on the areas of quality improvement, care coordination, health information technology (HIT), patient/provider education and engagement, and health services research. Although some of the recommendations have been the subject of discussion during the ongoing healthcare reform debate, and in fact have been reflected in some of the proposals under consideration, the recommendations are being released with an eye toward an ongoing and consistent commitment to improving healthcare — and health outcomes — in America.

According to a 2005 study published in the "New England Journal of Medicine", an estimated one-third to one-half of all patients in the United States do not take their medications as prescribed. The impact of this nonadherence is costly in terms of both quality of care and cost. In fact, recent research including work by New England Healthcare Institute (NEHI) and a 2004 study published in "Medical Care" suggested that costs resulting from nonadherence may be as high as $300 billion annually.

“Not only is poor medication adherence costly, but it also can be dangerous,” said Sally Greenberg, executive director of National Consumers League. “Because patients don’t take their medications for a variety of reasons, including cost, such as co-pays and deductibles, side effects, misconceptions or fears, and trouble with administration, we need to employ a multitude of strategies to improve adherence. Our efforts are focused on identifying key opportunities to improve the healthcare system and reduce barriers that keep patients from getting the best benefit from their medicines.”

To learn more about the five policy recommendations, please visit:

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Reducing Hospital Readmissions

The frequency and financial impact of Medicare readmissions, the posting of readmission rates for Medicare patients with heart attack, heart failure and pneumonia on the CMS Hospital Compare site and the tying of these rates to reimbursement are making healthcare organizations work harder to keep patients from returning to the hospital. Describe your organization's efforts by taking the HIN 2009 Hospital Readmissions Benchmark Survey and receive an e-summary of the results once the survey is completed.

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

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