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December 17, 2009 Volume VI, No. 30

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

With much of science focused on reducing childhood obesity, there is still scientific hope for reducing adult obesity. In this week's issue of the DM Update, discover how obese adolescents experience sleep apnea more than younger children and how watching less television affects calorie counts in obese adults. Also, tune in to a new NIH program to help reduce obesity rates among different populations.

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

This week's DM news:

Table of Contents

  1. Obesity and Obstructive Sleep Apnea
  2. Less TV Viewing and Burning Calories
  3. Transitional Care Collaboration
  4. Identifying Members in L.I.F.E. Program
  5. Healthcare Trends: Health Coaching in 2009
  6. Interventions to Reduce Obesity
  7. Healthcare Case Management

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Obesity Increases Risk for Obstructive Sleep Apnea in Adolescents, But Not in Younger Children

A study in an issue of the Journal of Clinical Sleep Medicine shows that being overweight or obese increases the risk for developing obstructive sleep apnea (OSA) in adolescents but not in younger children. Sleep and OSA severity were assessed by overnight polysomnography in 234 Caucasian children between the ages of 2 and 18 years. Participants were classified into six age groups, and having an average of at least one obstructive apnea or hypopnea per hour of sleep was considered to be indicative of OSA. Established growth charts corrected for age and sex were used to determine BMI z-scores and classify children as overweight (BMI greater than or equal to 85th percentile) or obese (BMI greater than or equal to 95th percentile).

Results indicate that the risk of OSA among Caucasian adolescents 12 years of age and older increased 3.5-fold with each standard-deviation increase in BMI z-score, while the risk of OSA did not significantly increase with increasing BMI among younger children. According to the authors, the results suggest that the increase in risk among overweight and obese adolescents may result from developmental changes such as reductions in upper airway tone and changes to anatomic structures.

Risk of OSA alone was not found to be greater among adolescents compared with younger children. Age groups also were not statistically different for measures of OSA severity or for percentage of individuals classified as having OSA, which was detected in 38 percent of 2- to 3-year-old children, 38 percent of 6- to 7-year-olds and 34 percent of adolescents between 12 and 18 years of age. When considering only children demonstrating OSA, there was a clear increase in the proportion of individuals who were overweight and obese with increasing age.

According to the study authors, developmental changes in the association between obesity and OSA may follow a different age trajectory among other ethnicities. African-American children appear to be at higher risk for OSA independent of obesity, and their pubertal development may occur earlier compared with Caucasian children.

To learn more about this research, please visit:

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Less TV Time May Help Overweight Adults Burn More Calories

Adults may stave off weight gain by simply spending less time watching television, according to a new study led by a researcher at the Stanford University School of Medicine. Overweight adults who cut television time in half were more active, burning more calories as a result. The study determined how reduced television watching affected calories eaten, energy used, body weight, time spent sleeping and the balance between calorie ingestion and activity in obese and overweight adults.

The study followed 36 adults, weighing in above the healthy range, who watched an average of five hours of television daily. After three observation weeks, half of the participants were limited to 50 percent less television for three additional weeks, using monitors that controlled their screen time. For the last week of each three-week period, participants wore activity-monitoring armbands, kept sleep logs and answered phone surveys about their diet.

The group instructed to halve their television did not change their calorie intake but burned 120 more calories a day on average, creating a trend of negative energy balance. The results from television reduction studies in children, similar to this one, have comparable effects on energy balance, though it was achieved through different means. With children, short-term study results were consistent with longer studies in which researchers found that instead of activity increasing, children’s food intake decreased and they lost weight. The difference may be because children’s diets are less set in stone, they may be more prone to advertisement-induced cravings or they are generally less inactive, said Jennifer Otten, Ph.D., postdoctoral scholar at the Stanford Prevention Research Center and lead author of the study.

To learn more about this research, please visit:

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Nurse-Case Manager Collaboration Reduces Avoidable Readmissions

Case managers and advanced practice nurses in Aetna's Transitional Care pilot have successfully partnered to reduce readmissions. Dr. Randall Krakauer, national medical director, Medicare at Aetna, describes the key focus and complementary roles that reduced 90-day readmissions by 25 percent. Dr. Krakauer also weighs in on the pros and cons of bundled payments, and why incentives alone will not significantly impact avoidable readmissions.

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Identifying Members & Measuring Outcomes in Florida L.I.F.E. Program

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's experts are Ethan Bird, M.P.H., B.S., community educator for Florida Hospital Zephyrhills at Adventist Health Systems and Bob Kamieneski, Ed.D, B.S., M. ED, administrative director for Florida Hospital Zephyrhills at Adventist Health Systems.

Question: How did you identify members and measure outcomes for your L.I.F.E. Program? What kind of incentives were involved?

Response: (Ethan Bird) Identifying members for the L.I.F.E. Program was an easy task. To do so, we advertised in the hospital, through the Intranet, in the employee magazine, on employee bulletin boards and in employee lounges across the campus. We also do a media hit to raise awareness. Once word gets out of the program and its cash incentives, it then takes on a life of its own. The program opens enrollment for a one-month period of time, twice a year. Florida Hospital Zephyrhills conducts an assessment every six months to measure members’ activities in the L.I.F.E. Program. At this assessment, participants’ weights and BMIs are recorded for those participating in the healthy BMI program. Those participating in the tobacco-free program will sign an affidavit stating they have been tobacco-free for the previous six-month period. And those participating in the physical activity component of the L.I.F.E. Program complete an exercise journal to measure their improvement.

(Bob Kamieneski) Cash incentives seem to do the trick for the L.I.F.E. Program. Other wellness programs that Florida Hospital Zephyrhills offers give out T-shirts, mugs and other such trinkets, but the cumulative $1,000 per year incentive among the healthy BMI, physical activity and tobacco-free components has proven most successful. Before the L.I.F.E. Program, Florida Hospital Zephyrhills had a number of wellness components, including a stress management program, an employee fitness center and various community education and health programs. Often, employees sign up for the community programs as well. Because these programs were already in place and wellness and fitness are part of the culture at Florida Hospital Zephyrhills, there was not much resistance or challenges to rolling out the L.I.F.E. Program. The biggest issue Florida Hospital Zephyrhills faced when rolling out the L.I.F.E. Program was with the healthy BMI component. Participants were only rewarded the $350 cash incentive if they fell into “normal BMI” categories, yet those who did in fact lose BMI points but were still “overweight” or “obese” received no reward. We wanted chatter around the hospital by people who were overweight or obese, and that happened. For six months that chatter went on, and then we came out with the BMI point loss [incentive.] Outside of that, [the feedback] has all been positive.

For more information on obesity and weight management, please visit:

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Healthcare Trends & Studies: Health Coaching in 2009 — Banking on Behavior Change

How do healthcare organizations use health coaching, and on which key behaviors do coaching interventions focus? By which modalities do they administer and monitor health coaching in their populations and how do they measure its effectiveness? The Healthcare Intelligence Network set out to answer these questions and others during its annual Health Coaching e-survey. This executive summary of responses from 212 healthcare organizations identifies emerging trends in the field of health coaching and its effect on healthcare utilization and spend.

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NIH Launches Innovative Program to Combat Obesity

The National Institutes of Health (NIH) is launching a $37 million program that will use findings from basic research on human behavior to develop more effective interventions to reduce obesity. The program, Translating Basic Behavioral and Social Science Discoveries into Interventions to Reduce Obesity, will fund interdisciplinary teams of researchers at seven research sites. Investigators will conduct experimental research, formative research to increase understanding of populations being studied, small studies known as proof of concept trials, and pilot and feasibility studies to identify promising new avenues for encouraging behaviors that prevent or treat obesity.

The program's studies focus on diverse populations at high risk of being overweight or obese, including Latino and African-American adults, African-American adolescents, low-income populations, pregnant women and women in the menopausal transition. The interventions include creative new approaches to promote awareness of specific eating behaviors, decrease the desire for high-calorie foods, reduce stress-related eating, increase motivation to adhere to weight loss strategies, engage an individual's social networks and communities to encourage physical activity, and improve sleep patterns. Brain scans will also be used to understand brain mechanisms in obesity that might guide the development of new interventions.

The research projects, principal investigators, study sites and the NIH sponsors include SCALE, Translating Habituation Research to Interventions for Pediatric Obesity, Increasing Sleep Duration: A Novel Approach to Weight Control, and many more.

To learn more about this research, please visit:

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Healthcare Case Management

More than 75 healthcare companies have already described how case managers are playing a larger role in the coordination of all phases of patient care, from management of the chronically ill in primary care offices to monitoring hospitalized patients from admission through discharge to overseeing care of residents of long-term care facilities. Complete HIN's Survey of the Month on Healthcare Case Management by January 4, 2010 and receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

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