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February 18, 2010 Volume VI, No. 38

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

According to the National Multiple Sclerosis (MS) Society, approximately 400,000 Americans and 2.5 million worldwide have MS. Every week, another 200 people are diagnosed. In this week's issue, discover the link between drinking milk while pregnant and a baby's risk of MS, as well as new research on blood flow in MS patients.

You will also learn about the benefits of a disease therapy management program for MS patients.

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

This week's DM news:

Table of Contents

  1. Milk May Lower MS Risk in Babies
  2. MS Patients & Abnormal Blood Flow
  3. Medication Therapy Management
  4. Patient Education in the Medical Home
  5. Healthcare Trends: Changing Lives with Lifestyle Management
  6. MS Treatment Adherence
  7. Health & Wellness Incentives Use

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Please send comments, questions and replies to jpapay@hin.com.

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Drinking Milk During Pregnancy May Lower Baby's Risk of MS

Drinking milk during pregnancy may help reduce a baby’s chances of developing MS as an adult, according to a preliminary study that will be presented in April at the American Academy of Neurology’s annual meeting in Toronto.

The study involved 35,794 nurses whose mothers completed a questionnaire in 2001 about their experiences and diet during pregnancy with their nurse-daughter. Of the nurses studied, 199 women developed MS over the 16-year study period. Researchers found that the risk of MS was lower among women born to mothers with high milk or dietary vitamin D intake in pregnancy.

“The risk of MS among daughters whose mothers consumed four glasses of milk per day was 56 percent lower than daughters whose mothers consumed less than three glasses of milk per month,” said Fariba Mirzaei, M.D., with the Harvard School of Public Health in Boston. “We also found the risk of MS among daughters whose mothers were in the top 20 percent of vitamin D intake during pregnancy was 45 percent lower than daughters whose mothers were in the bottom 20 percent for vitamin D intake during pregnancy. There is growing evidence that vitamin D has an effect on MS. The results of this study suggest that this effect may begin in the womb,” said Dr. Mirzaei.

To learn more about this research, please visit:

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MS Linked to Restricted Blood Flow in the Brain

More than 55 percent of MS patients participating in the initial phase of the first randomized clinical study to determine if persons with MS exhibit narrowing of the extracranial veins, causing restriction of normal outflow of blood from the brain, were found to have the abnormality. When the 10.2 percent of subjects in which results were borderline were excluded, the percentage of affected MS patients rose to 62.5 percent, preliminary results show, compared to 25.9 percent of healthy controls. Researchers of the study hypothesize that this narrowing restricts the normal outflow of blood from the brain, resulting in alterations in the blood flow patterns within the brain that eventually cause injury to brain tissue and degeneration of neurons.

The preliminary results are based on the first 500 participants in the Combined Transcranial and Extracranial Venous Doppler Evaluation (CTEVD) study, which began at the University at Buffalo (UB) in April 2009. Investigators are planning to examine 500 additional subjects, who will be assessed in the second phase of the study with more advanced diagnostic tools. The first 500 patients, both adults and children, were grouped based on their diagnosis: MS, clinically isolated syndrome (CIS) and "other neurologic diseases" (OND), in addition to healthy controls. All participants in the first phase underwent ultrasound (Doppler) scans of the head and neck in different body postures to view the direction of venous blood flow. MS subjects also underwent MRI scans of the brain to measure iron deposits in lesions and surrounding areas of the brain, using a method called susceptibility-weighted imaging. Iron findings on these images will be related to subjects' disability and neuropsychological symptoms. The investigation is the first step in determining if a condition called chronic cerebrospinal venous insufficiency (CCSVI) is a major risk factor for MS. CCSVI is a complex vascular condition discovered and described by Paolo Zamboni, M.D., from Italy's University of Ferrara. Dr. Zamboni's original investigation in a group of 65 patients and 235 controls showed CCSVI to be associated strongly with MS, increasing the risk of having MS by 43-fold.

Of the total participants in the CTEVD study, 97.2 percent were adults, with the 280 MS patients comprising the largest disease cohort examined in the study to date. The majority of MS subjects were diagnosed with the relapsing-remitting form of MS. There were 161 healthy controls. Doppler scan results were reported on five specific criteria that affect venous blood flow. Patients who met at least two of the criteria were considered to have CCSVI. When the 10.2 percent borderline subjects were included in the "normal" category (no venous insufficiency), the CCSVI prevalence was 56.4 percent in MS subjects and 22.4 percent in healthy controls. In this large MS cohort, the presence of CCSVI did suggest an association with disease progression, a finding that was not shown in Dr. Zamboni's smaller cohort. The finding that 22.4 percent of healthy controls also met two CCSVI criteria requires continuing investigation.

To learn more about this research, please visit:

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Medication Therapy Management in the Patient-Centered Medical Home

The pharmacist has a natural and important role in patient medication reconciliation and review, explains Dr. Beth Chester, senior director of clinical pharmacy services and quality, Kaiser Permanente Colorado. She describes the dramatic impact that a pilot pharmacist intervention had on emergency department visits and mortality rates among patients just discharged from skilled nursing facilities (SNFs) once the health plan's pharmacists stepped in to monitor medication therapy in this population.

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Patient Education in the Medical Home

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Barbara Wall, president and CEO of Hagen Wall Consulting.

Question: What patient education tools provide the greatest ROI in the patient-centered medical home — for instance, disease self-management information, wellness information, information about appropriate ER use, etc.?

Response: (Barbara Wall) As long as the basis of the patient teaching tools is written at a standard grade level, most of them are pretty good. For Medicaid the grade level is usually at about a sixth grade level and for a commercial population the reading grade level is junior high school or about eighth grade level. The most effective use in patient teaching that I have seen is when there is one-to-one contact between the patient educator or DM nurse and the patient. There seems to be a much greater degree of engagement in retention and buy-in by the patient when there is interaction on a one-to-one basis in teaching, rather than the educational material simply being in hard copy accessed by the patient alone.

For more information on patient education in the patient-centered medical home, please visit:

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Healthcare Trends & Studies: Changing Lives with Lifestyle Management — Taking the Pulse of Population Health Programs

Abandoning behaviors that are detrimental to one’s health is no simple feat. That's why numerous healthcare organizations are launching lifestyle management programs for individuals with life-threatening conditions such as diabetes, heart disease and obesity. This executive summary provides the general character of more than 60 such initiatives, including the differing approaches and techniques in identification, treatment and outcome assessment.

To download this complimentary white paper, please visit:

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Specialized MS Support Programs Increase Treatment Adherence, Reduce Costs

A new study reveals that MS patients enrolled in a seven-month disease therapy management (DTM) program show greater adherence to injectable MS medications and treatment persistence than patients who receive injectable MS medications through a community pharmacy. In addition, the percentage of DTM patients who reported an MS relapse decreased by more than a third at the end of the program. These findings provide important insights into the benefits that DTM programs provide in helping patients better manage their health, while also yielding potential cost savings. About 97 percent of participants reported that the DTM program was "very helpful" or "somewhat helpful" in enabling them to better manage their health. The program was rated as "very good" or "excellent" by more than 91 percent of patients.

The study shows that DTM programs can have a positive impact on the rate of medication adherence and treatment persistence, resulting in better health outcomes for MS patients and cost savings for the health system. These findings provide additional evidence that high-touch clinical support programs can reduce additional medical spend incurred by patients with MS. Previously published research has shown that insured patients with MS incur two to three times more health-related expenses than insured patients who do not suffer from MS. Based on this new study, which showed a 33.6 percent reduction in MS relapses in 283 patients, the DTM intervention would save an estimated $173,246 in relapse costs (based on $13,026/MS relapse), or $612 per patient participating in the program.

Among the key study findings was that the DTM group demonstrated a significantly greater persistence on therapy (220 days) compared with the two control groups (specialty pharmacy, 188 days; and retail pharmacy, 177 days), and a lower medication discontinuation rate (7.7 percent vs. 21.8 percent for specialty pharmacy and 28.2 percent for retail pharmacy). Medication adherence for MS patients completing the DTM program was slightly higher (mean medication possession (MPR) = 0.92) compared to the control patients simply receiving their MS medications from a specialty pharmacy (MPR = 0.90) and significantly higher compared to the control patients receiving their MS medications from a community pharmacy (MPR = 0.86).

The study found that MS relapses were reported by 14 percent of patients at program onset and by 9.3 percent of patients at the end of the program ((p = 0.03) — a 33.6 percent relapse decrease). Because of the improved medication persistence demonstrated in patients participating in the program beyond the seven-month mark (where patients who did not participate in the program typically discontinued their medication), this study does not address the question of whether patients who had participated in the program would likely experience fewer relapses after the seven-month mark than those who did not.

To learn more about this research, please visit:

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Health & Wellness Incentives Use

The use of economic incentives to drive engagement and results from wellness and prevention programs continues to proliferate, both as a response to escalating healthcare costs and a shift of more health ownership to consumers. Join the more than 80 organizations that have already described how they use incentives to promote health and wellness. Complete HIN's second annual Survey of the Month on this topic by February 28, 2010. You'll receive a free executive summary of the compiled results, and your responses will be kept strictly confidential.

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

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