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January 28, 2010 Volume VI, No. 35

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

This week's issue of the DM Update is all about the heart and keeping it healthy. Discover the link between COPD and heart function, as well as the risk of heart disease among America's youth. And our prevention story for this week answers the following question about reducing heart attack risk: should treatment be tailored toward an individual's heart attack risk or cholesterol levels?

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

This week's DM news:

Table of Contents

  1. American Youths Have Abnormal Lipid Levels
  2. COPD Limits Heart Function
  3. Single Tool Improves Care Delivery
  4. Data Mining to Identify Unsuitable Patients
  5. Healthcare Trends: Role-Based Access Governance & HIPAA Compliance
  6. Heart Attack Risk & Treatment
  7. Medication Adherence

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Publisher:
Melanie Matthews, mmatthews@hin.com

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One in Five American Youths Have Abnormal Lipid Levels, At Risk for Heart Disease

Twenty percent of young people aged 12-19 years in the United States have at least one abnormal lipid level, according to a study from the CDC. Abnormal lipid levels are major risk factors for heart disease, the leading cause of death among adults in the United States. The report examined data from 1999–2006 from the National Health and Nutrition Examination Survey (NHANES), an ongoing study that explores the health and nutritional status of about 6,000 participants every year. Researchers analyzed measurements of low-density lipoprotein or “bad” cholesterol (LDL-C); high-density lipoprotein or “good” cholesterol (HDL-C) and triglycerides.

The researchers found that young people who were overweight or obese were more likely to have one or more abnormal lipid levels compared to normal weight youth. Fourteen percent of normal weight, 22 percent of overweight and 43 percent of obese youth had one or more abnormal lipid levels. The study also found that 32 percent of these young people would be candidates for lipid screening based on American Academy of Pediatrics (AAP) guidelines. The AAP recommends lipid screening for young people with a family history of high blood cholesterol or premature cardiovascular disease, or the presence of at least one major risk factor for heart disease, such as smoking, high blood pressure, diabetes or overweight/obesity.

Reviewing health indicators for 3,125 youths, researchers found that differences in lipid levels were associated with sex, age and race/ethnicity. For instance, more boys (24 percent) than girls (16 percent) had at least one abnormal lipid level, 14- and 15-year-olds (9 percent) and 18- and 19-year-olds (10 percent) were more likely to have low HDL cholesterol levels than 12- and 13-year-olds (5 percent), and non-Hispanic white youths were more likely to have low levels of HDL cholesterol (8 percent) and high triglycerides (12 percent), compared to non-Hispanic black youths (5 percent and 4 percent, respectively).

To learn more about this research, please visit:
http://www.cdc.gov/media/...

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Even Mild COPD Limits Heart Function

A common lung condition, chronic obstructive pulmonary disease (COPD), diminishes the heart's ability to pump effectively even when the disease has no or mild symptoms, according to research published in a January issue of the New England Journal of Medicine. The study is the first time researchers have shown strong links between heart function and mild COPD. The research was funded by the National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health.

Using breathing tests and imaging studies of the chest, researchers measured heart and lung structure and function in 2,816 generally healthy adults, with an average age of 61 years. Sensitive MRI and CT scans uncovered mild abnormalities in heart and lung function in many participants. They discovered that the link between lung and heart function was strongest in current smokers, who are at risk for both diseases, and especially in those with emphysema. The findings also appeared, to a lesser extent, in people with mild COPD who had never smoked.

Researchers have long known that severe cases of COPD have harmful effects on the heart, decreasing its ability to pump blood effectively. The new results suggest that these changes in the heart occur much earlier than previously believed, in mild cases and even before symptoms appear. One in five Americans over the age of 45 has COPD, but as many as half of them may not even be aware of it. According to Graham Barr, M.D., Dr. P.H., assistant professor of medicine and epidemiology at Columbia University Medical Center in New York City, "the study results raise the intriguing possibility that treating lung disease may, in the future, improve heart function. Further research is needed to prove whether treating mild COPD will help the heart work better."

To learn more about this research, please visit:
http://www.nih.gov/news/health/jan2010/nhlbi-20.htm

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Single Tool Improves Delivery of Evidence-Based Care

A year into the Colorado multi-payor medical home pilot whose practices provide care to 30,000 patients, Julie Schilz, B.S.N., M.B.A., prescribes a single tool that can help transform practices, improve quality and deliver evidence-based care. It's not an EHR, says the manager of the Improving Performance in Practice and Patient-Centered Medical Home (PCMH) initiatives for the Colorado Clinical Guidelines Collaborative, who lists this tool's four key functionalities.

To listen to this complimentary HIN podcast, please visit:
http://www.hin.com/podcasts/podcast.htm#110

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Data Mining to Identify Unsuitable Patients

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's experts are Katherine Scher, R.N., C.C.M., program manager for the Center for Clinical Care Design at Henry Ford Health System; and Dr. Randall Williams, M.D., F.A.C.C., chief executive officer with Pharos Innovations.

Question: Can you describe how you used codes to remove patients unsuitable for care management programs?

Response: (Katherine Scher) When we identified the patient population for heart failure, we also looked at certain key comorbidities that we knew would help us eliminate patients who wouldn’t benefit from this care. We removed end-stage renal disease patients and certain cancer patients. Through our administrative data, we were able to identify some patients who were in skilled nursing facilities (SNFs) and remove them as well.

(Dr. Randall Williams) We look in code sets for facilities codes that would indicate someone who is in a hospice program, in a renal dialysis program or in an institutional facility setting. We believe that the program was not designed to case-manage individuals who fit those criteria.

For more details on identifying suitable patients for care management, please visit:
http://store.hin.com/product.asp?itemid=3915

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

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There are other free email newsletters available from HIN!

ReadmissionsRx is a new monthly e-newsletter delivering strategies to reduce hospital readmissions that encompass care plan development, case management, care transitions, pre- and post discharge planning, medication reconciliation and much more — with a special focus on reducing rehospitalizations among the Medicare population.

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Healthcare Trends & Studies: Role-Based Access Governance and HIPAA Compliance — A Pragmatic Approach

The recently passed Health Information Technology for Economic and Clinical Health Act (HITECH) will impose more stringent regulatory and security requirements to the privacy rules of HIPAA. Compliance with the letter of the guideline can be difficult for organizations without strong access governance processes and policies. This paper focuses on a set of best practices for implementing an access governance framework and the specific access controls requirements for HIPAA/HITECH.

To download this complimentary white paper, please visit:
http://www.hin.com/library/registerrba.html

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Is Focus on Heart Attack Risk More Effective Than Cholesterol Level for Treatment?

A new study by the University of Michigan (U-M) Medical School and Veterans Affairs Ann Arbor Healthcare System challenges the medical thinking that the lower the cholesterol, the better. Tailoring treatment to a patient’s overall heart attack risk, by considering factors such as age, family history and smoking status, was more effective, and used fewer high-dose statins, than current strategies to drive down cholesterol to a certain target, according to the U-M study. While study authors support the use of cholesterol-lowering statins, they conclude that patients and their doctors should consider all the factors that put them at risk for heart attack and strokes.

The National Cholesterol Education Program recommends harmful LDL cholesterol levels should be less than 130 for most people. High risk patients should be pushed even lower — to less than 70. The U-M study, though, took a different approach called tailored treatment, which uses a person’s risk factors and mathematical models to calculate the expected benefit of treatment by considering: a person’s risk of a heart attack or stroke without treatment, how much a statin decreases the risk and potential harms from the treatment.

In the recent study, U-M physicians who worked with Yale University School of Medicine used data from statin trials that included Americans ages 30-75 with no history of heart attack. Study authors evaluated the benefit of five years of treatment that was tailored on coronary artery disease risk factors such as age, family history, diabetes, high blood pressure, smoking status and recently CRP, C-reactive protein. The study found that the tailored approach was more efficient (more benefit per person treated) and prevented substantially more heart attacks, strokes and cardiovascular deaths than the currently recommended treat-to-target approaches. The tailored strategy treated fewer individuals with high-dose statins and saved 500,000 more quality-adjusted life years.

According to Rodney A. Hayward, M.D., director of the Veterans Affairs Center for Health Services Research and Development and a professor of internal medicine at the U-M Medical School, “the bottom line message — knowing your overall heart attack risk is more important than knowing your cholesterol level. If your overall risk is elevated, you should probably be on a statin regardless of what your cholesterol is and if your risk is very high, you should probably be on a high dose of statin. However, if your LDL cholesterol is high, but your overall cardiac risk is low, taking a statin does not make sense for you. If your cholesterol is your only risk factor and you’re younger, you should work on diet and exercise.”

To learn more about this research, please visit:
http://www2.med.umich.edu/prmc/media/newsroom/...

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Medication Adherence

Of 1.8 billion prescriptions dispensed annually in the U.S., only 50 percent are taken correctly by the patient, according to the World Health Organization. Beyond increasing risk of death, poor medication adherence is tied to as much as $290 billion annually in increased medical costs and responsible for 33 to 69 percent of all medication-related hospital admissions in the U.S., at a cost of about $100 billion per year. Join the 105 companies that have already shared their organization's efforts to improve medication adherence by completing HIN's Survey of the Month by January 31, 2010. You'll 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:
http://www.surveymonkey.com/s/medication_adherence

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