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December 2, 2010 Volume VII, No. 21

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

Even though the CDC reported last month that diabetes could affect one in three Americans by 2050, the American Diabetes Association says mortality rates for Type 1 diabetes are decreasing. Find out the mortality rates by gender and ethnic population, as well as the possible reasons behind this decrease in this week's issue. Also this week, learn more about the role of registered dietitians in diabetes management, and the types of cancers diagnosed late despite available screenings.

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

This week's DM news:

Table of Contents

  1. Diabetes Mortality
  2. Cancer Diagnosis & Screenings
  3. ACOs and Clinical Integration
  4. Case Manager in Diabetes Medical Home
  5. Staffing to Curb Avoidable ER Use
  6. 2010 Telehealth Benchmarks
  7. Managing Diabetes with Registered Dietitians
  8. Reducing Hospital Readmissions in 2010

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Type 1 Diabetes Mortality Rates Dropping

Mortality rates for people with type 1 diabetes are decreasing, but overall remain seven times higher than those of the general population — likely as a result of long-term complications, a study in the December issue of Diabetes Care reports. And while there were no significant differences in mortality rates between genders, women with type 1 diabetes were 13 times more likely to die than women who did not have diabetes, reported researchers from the University of Pittsburgh. Also in this study, a much higher proportion of African Americans (50.6 percent) died than Caucasians (24 percent). The study looked at people in the Allegheny County, Pa. area who had type 1 diabetes diagnosed as a child between 1965 and 1979 and at the time of analysis had a duration of diabetes between 28 and 43 years, and explored differences in mortality based on sex, race (Caucasian vs. African American) and year of diagnosis.

Overall, mortality rates for people with type 1 diabetes fell significantly in this community-based population over the past several decades, the study found. For those diagnosed between 1965 and 1969, mortality rates were 9.3 times higher than the general population. However, for those most recently diagnosed (1975-1979), the rate was just 5.6 times higher, showing a clear decline. "It looks like the main improvement in those most recently diagnosed is related to dramatically reducing mortality in the first five years after diagnosis," said Dr. Aaron Secrest, lead author of the paper. "We think its probably a result of better management and awareness of diabetes control, leading to providers and patients doing a better job of monitoring for acute complications."

Overall, reductions in mortality are most likely due to the tremendous improvements in treatment and care during the 1980s and 1990s, the researchers noted. In particular, blood glucose self-monitoring, A1C testing and use of new blood pressure medications such as angiotensin-converting enzyme inhibitors, which also help protect against diabetic kidney disease. These changes have greatly improved both blood sugar and blood pressure control, often the cause of life-threatening complications.

To learn more about this research, please visit:

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Cancers Diagnosed at Late Stages Despite Available Screening Tests

Almost half of colorectal and cervical cancer cases and a third of breast cancer cases in the United States are diagnosed at late stages of the diseases when treatment is more difficult, according to a new report released by the CDC. In this first report to highlight the nationwide incidence of late-stage cancer diagnosis and cancer screening prevalence, the incidence rates of late-stage cancers differed by age, race/ethnicity and state.

Researchers examined stage-specific cancer incidence rates and screening prevalence for breast, cervical and colorectal cancer by demographic characteristics in states. National data on new cancer cases were obtained from cancer registries affiliated with the CDC National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. State-level cancer screening data were obtained from the CDC Behavioral Risk Factor Surveillance System. Authors of the report noted that differences in late-stage cancer diagnoses may be partially explained by differences in screening rates in locations and among different demographic groups. The U.S. Preventive Services Task Force recommends the following evidence-based population-based cancer screenings:

  • Men and women aged 50-75 years at average risk for colorectal cancer should get screened with any of the three tests: a fecal occult blood test every year, a flexible sigmoidoscopy every five years, or a colonoscopy every 10 years.
  • Women aged 50-74 years should be screened with mammography every two years.
  • Screening for cervical cancer with the Pap test should begin for women within three years of beginning sexual activity or at age 21 (whichever comes first). Furthermore, women should be screened annually with three consecutive normal Pap tests and then at least every three years up to age 64.
Significant findings of the study include:
  • Incidence rates of late-stage colorectal cancer increased with age and were highest among black men and women.
  • Incidence rates of late-stage breast cancer were highest among women aged 70-79 years and black women.
  • Incidence rates of late-stage cervical cancer were highest among women aged 50-79 years and Hispanic women.
  • Late-stage colon and rectum incidence rates ranged from 51.0 to 86.5, and were highest in Connecticut, Delaware, Illinois, Iowa, Kentucky, Louisiana, Maine, Nebraska, New Jersey and Pennsylvania.
  • Late-stage breast cancer incidence rates ranged from 92.2 to 132.1, and were highest in Alabama, the District of Columbia, Kansas, Louisiana, Mississippi, New Jersey, Oklahoma, Pennsylvania, Tennessee and Washington.
  • Late-stage cervical cancer incidence rates ranged from 3.0 to 8.3, and were highest in Arkansas, the District of Columbia, Illinois, Kentucky, Louisiana, Mississippi, Nevada, New Mexico and Oklahoma.
The CDC's Colorectal Cancer Control Program funds 25 states and 4 tribal organizations across the U.S. to increase rates of colorectal cancer screening among men and women 50 years of age and older through population-based approaches such as policy and health systems change, outreach, case management, and selective provision of direct screening services. The CDC National Breast and Cervical Cancer Early Detection Program provides access to breast and cervical cancer screening services to low-income, uninsured and underserved women in 50 states, the District of Columbia, five territories and 12 tribes.

To learn more about this research, please visit:

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Framing an ACO Through Clinical Integration of Independent Physicians

Thinking about creating an accountable care organization? The clinical integration of healthcare providers can be the first step, facilitating the coordination of services required for shared accountability and reward. Dr. Mark Shields, senior medical director with Advocate Physician Partners, describes the logistics of training 3,400 providers on clinical integration, the importance of the physician peer group in this effort, and the business case for devoting three of Advocate's 41 performance measures to smoking cessation and prevention.

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The Role of a Case Manager in a Diabetes Medical Home

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Roberta Burgess, R.N., nurse case manager for Community Care Plan of Eastern Carolina with Heritage Hospital in Tarboro, North Carolina.

Question: What is the role of case managers in your diabetes program and how do their efforts translate into healthcare savings?

Response: Case managers work with the providers in the practice, and when our clients go to appointments sometimes were there to meet them or transport them. Our role is to help facilitate communication between the client and the physician. We also do home visits with our clients in the community, provide education and motivation and talk to high-risk diabetics, new diabetics and high-cost diabetics. In the past we saved $230 million in North Carolina.

For more information on a diabetes medical home, please visit:

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Staffing to Curb Avoidable ER Use

As consumers and payors take on greater responsibility for the efficiency of the healthcare system, healthcare organizations are targeting avoidable emergency room use. We wanted to see the staffing models in use to reduce avoidable ER use.

Click here to view the chart.

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2010 Telehealth Benchmarks

This white paper captures the nuts and bolts of telehealth services offered by 111 healthcare organizations who responded to HIN's September 2010 Telehealth and Telemedicine survey, including top technologies, targeted populations and prevalence of remote monitoring.

To download this complimentary white paper, please visit:

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Registered Dietitians Play Essential Role in Effective Management of Type 1, Type 2 Diabetes in Adults

Proper nutrition therapy is essential for the successful management of type 1 and type 2 diabetes and registered dietitians (RDs) can play a key role as part of the healthcare team. An article in the December issue of the "Journal of the American Dietetic Association" reviews the evidence and nutrition practice recommendations presented in the American Dietetic Association Nutrition Practice Guidelines for Type 1 and Type 2 Diabetes in Adults. This complete and systematic review presents 29 key nutrition practice guidelines in order to best support people with diabetes.

The authors reviewed the research literature to distill evidence-based nutrition recommendations and practice guidelines regarding the major nutrition therapy factors — carbohydrates (intake, sucrose, non-nutritive sweeteners, glycemic index, fiber), protein intake, cardiovascular disease and weight management. Armed with information regarding what works and why, RDs can encourage lifestyle changes and select appropriate interventions based on key recommendations that include consistency in day-to-day carbohydrate intake, adjusting insulin doses to match carbohydrate intake, substitution of sucrose-containing foods, usual protein intake, cardioprotective nutrition interventions, weight management strategies, regular physical activity and use of self-monitored blood glucose data. Key recommendations:

  • Consistency in day-to-day carbohydrate intake for persons with type 2 diabetes.
  • Adjusting insulin dose to match carbohydrate intake for persons with type 1 diabetes.
  • Focusing on total carbohydrate intake rather than the type of carbohydrate.
  • Cardio protective nutrition interventions.
  • Weight management strategies.
  • Regular physical activity.
  • Use of self glucose monitoring data to determine if goals are being met.
To learn more about this research, please visit:

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Reducing Hospital Readmissions in 2010

Spurred on by incentives from public and private payors, healthcare organizations are working hard to reduce avoidable rehospitalizations, especially among Medicare patients. Describe your organization's efforts to reduce hospital readmissions by taking HIN's second annual Reducing Hospital Readmissions Benchmark Survey. Respond by December 31 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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