Disease Management Update
Volume IV, No. 34
December 20, 2007

Dear Healthcare Intelligence Network Client,

An estimated 40,000 children are born with a heart defect each year, and in most cases, surgery can help these children, even when it comes to severe defects. This week's Disease Management Update features a study from the University of Michigan that found that babies born with major heart defects are less likely to die if treated at hospitals that perform many operations a year. A related story examines the effects that stimulants used to treat ADHD in children can have on their hearts.

Visit HIN's blog for some tips on maintaining heart health in children.

Your colleague in the business of healthcare,
Laura M. Greene
Editor, Disease Management Update

If this is a forwarded copy of Disease Management Update and you like what you see, you can register to receive your own copy of this complimentary service. Sign up at:

Table of Contents

  1. Positive Outcomes Increase for Babies with Major Heart Defects if Treated at High-volume Centers
  2. Disease Management Q&A: Heart Health Home Visits
  3. HealthSounds Podcast: Medical Homes & Managing Chronic Conditions
  4. Study Examines Heart Risks of Stimulants in Children with ADHD
  5. Survey of the Month: Healthcare Consumerism
  6. Children's Hospital Streamlines Medical Record Processes

1. Positive Outcomes Increase for Babies with Major Heart Defects if Treated at High-volume Centers

In the first national study of this issue, a team of University of Michigan researchers found that infants with specific complex heart defects are much less likely to die before leaving the hospital if they are treated at the centers that treat the largest numbers of these patients. This relationship between hospital volume and mortality has been seen in adult heart operations, but the new study suggests it holds true for infants as well.

The study analyzed data for two of the most severe congenital heart defects: transposition of the great arteries (TGA), in which the major blood vessels leading between the heart and lungs are switched, and hypoplastic left heart syndrome (HLHS), in which the left side of the heart does not develop properly. Both defects are lethal if not treated within a few weeks of birth, with operations called the arterial switch operation for TGA and the Norwood procedure for HLHS. Infants may need additional operations later in life, but these initial open-heart procedures are critical for their survival.

The study shows that an infantís risk of dying in the hospital during or after their operation varied greatly depending on the number of each procedure performed that year at the hospital where they were treated. Mortality rates ranged from more than 10 percent to less than 1 percent for the arterial switch operation, and from more than 35 percent to around 10 percent for the Norwood procedure.

To learn more about this study, please visit:

2. Disease Management Q&A: Heart Health Home Visits

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Michele Gilbert, education coordinator of the heart failure team at magnet hospital Hackensack University Medical Center (HUMC).

Question: What are the components and goals of the home visits conducted by the heart failure team?

Response: (Michele Gilbert) We have spent a lot of time teaching our home care nurses to be astute observers. One thing the nurse will do is interview the patient regarding their health practices and understanding of the disease. We give patients basic educational information. When the nurse conducts the visit, she does a complete physical assessment, as well as an assessment of the patientís functional abilities. We use the Minnesota Living With Heart Failure Questionnaire, which addresses functional status for the patient. We use that at the first and last visits to ensure that the patientís functional status and ability to self-manage is improving. We find out what the patient has been eating and what theyíre doing. We get our baseline. On subsequent visits, the nurse might empty the patientís pantry and show them how much sodium theyíve been eating. They ensure the patient understands where to find hidden sources of sodium. The nurse continues to assess the patientís progress. They will provide them with a daily system for weighing themselves and recording their weight. The patientís ability to self-medicate is also assessed. If they donít have a system for taking their medications, we provide one, such as a seven-day pillbox with four compartments.

For more details on managing heart failure patients, please visit:

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

3. HealthSounds Podcast: Medical Homes & Managing Chronic Conditions

In this week's disease management podcast, Elizabeth Reardon, a consultant with Commonwealth Medicine in Massachusetts, suggests tactics and resources for drawing families and communities into the medical home model.

To listen to this complimentary HIN podcast, please visit:

4. Study Examines Heart Risks of Stimulants in Children with ADHD

Stimulant medications used to treat children with attention-deficit hyperactivity disorder (ADHD) may be responsible for an increased number of visits to the emergency room or doctorís office because of cardiac symptoms, but deaths or serious heart complications are rare, a new University of Florida (UF) study reveals.

A team of researchers in pharmacy, pediatric medicine and psychiatry analyzed records from 55,000 children ages 3 to 20 who had ADHD and were undergoing treatment between 1994 to 2004. Children who used central nervous system stimulants were 20 percent more likely to visit an emergency clinic or doctorís office with cardiac-related symptoms, such as a racing heartbeat, than children who had never used or discontinued treatment. The researchers also reported that the rates of death or hospital admission for serious heart conditions were no different than the national rates among the general population, but the total number of events was too small to allow definite conclusions.

The UF research teamís recent findings raise several important issues that warrant further investigation. Critical concerns include stimulant safety in populations with cardiac risk factors and in those who use the drugs for several years. The UF study found that more than 25 percent of stimulant users also used antidepressant or antipsychotic drugs, which are known to affect the heart and blood pressure as well.

To learn more about this study's findings, please visit:

5. Survey of the Month: Healthcare Consumerism

Complete our survey on healthcare consumerism efforts by December 31, and you'll get a free executive summary of the compiled results.

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

6. Children's Hospital Streamlines Medical Record Processes

Since the hospital is a round-the-clock organization, the Childrenís Hospital needed the ability to continue to provide optimal patient care while still accessing and updating patient information. They needed to have the right tools to ensure patient data was linked together properly while also providing critical information about where and why duplicates may be occurring. To help them solve their challenges, the Childrenís Hospital turned to Initiate Systems to implement the Initiate Identity Hubô software, an EMPI solution that helps healthcare organizations leverage the investment already made in core applications and patient information.

To download this complimentary white paper, please visit:
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