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March 4, 2010 Volume VI, No. 40

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

This week's issue highlights how location and race can play a part in disease management and the link between sociodemographics and cancer screenings. Also, a CDC report outlines where hospitalizations for heart disease occur the most among the elderly.

Geography affects funding for disease prevention, too. Find out how federal and state budget cuts are affecting the states' disease prevention efforts.

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

This week's DM news:

Table of Contents

  1. Cancer Screenings & Sociodemographics
  2. Highest Heart Disease Hospitalizations
  3. Patient Activation Measure
  4. Collaborative Care for Elderly
  5. Healthcare Trends: Cultural Diversity in Healthcare
  6. Disease Prevention in Different States
  7. Medical Homes in 2010

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

Melanie Matthews, mmatthews@hin.com

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Sociodemographics Drive Patients' Willingness to Participate in Cancer Screenings

Boston University School of Medicine’s (BUSM) researchers have found that sociodemographics are related to a patient's willingness to participate in cancer screenings. They found this was more important than both attitudinal barriers and medical facilitors. Prior studies have shown that screenings are crucial in identifying cancer in its early stages, and minorities have lower screening rates for certain types of cancer, such as cervical and colorectal cancer. Researchers at BUSM wanted to find out why the screening rates among racial and ethnic minorities vary compared to those of the white, non-Hispanic community.

Researchers examined patients' agreeability to engage in cancer screening, in the context of varied symptoms and screening settings among a diverse group of individuals from multiple geographic areas. The study assessed the influences of race and ethnicity, relative to sociodemographic factors of both positive and negative attitudes and beliefs concerning cancer screening, as well as the willingness to utilize screenings in general. A random sample was conducted using telephone interviews from three cities: San Juan, Puerto Rico, Baltimore and New York City. Respondents reported their sociodemographic characteristics and attitudes about barriers and facilitators of cancer screenings. These individuals also reported their amenability to have cancer screening within four scenarios: when done in the community as opposed to one's doctors' office and whether or not they had symptoms.

Less-educated individuals with lower incomes received fewer cancer screenings than those with higher levels of each. These rates may lead to disparities in cancer-related mortality. Racial and ethnic minority status, age and lower income were frequently associated with willingness to receiving a cancer screening. Prior findings suggest that negative attitudes towards screenings include fear of pain or diagnosis, disbelief in the efficiency of the tests or generalized distrust of others were most predominant among racial and ethnic minorities, and accounts for their lower rates of cancer screening. The researchers also found that individuals were most willing to participate in a screening when they were examined by their personal doctor and had symptoms of cancer. Cancer screening campaigns should affect attitudinal changes whenever possible, and recognize that targeting specific population groups may be necessary.

To learn more about this research, please visit:

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Highest Heart Disease Hospitalizations Occur Among Blacks

Heart disease hospitalization rates among Americans aged 65 years and older vary substantially depending on where they live, according to a new CDC report. The "Atlas of Heart Disease Hospitalizations Among Medicare Beneficiaries" shows that the highest hospitalization rates occur among blacks compared to other racial and ethnic groups. Hospitalization rates were also highest in counties located primarily in Appalachia, the Mississippi Delta, Texas and Oklahoma. A significant number of Medicare beneficiaries live in counties without hospitals capable of providing specialized heart disease treatment.

The atlas provides for the first time statistics about heart disease hospitalizations at the county level. Data came from the Medicare records of more than 28 million people each year between 2000 and 2006 in the 50 states, Washington, D.C., Puerto Rico and the U.S. Virgin Islands. The report documented an average of 2.1 million hospitalizations for heart disease each year. Heart disease is the nation's leading cause of death. In 2010, it is estimated to cost the United States $316.4 billion in healthcare services, medications and lost productivity.

In states with the highest heart disease hospitalization rate, the burden is generally two times higher than states with the lowest rates. For instance, in Louisiana there were 95.2 hospitalizations for every 1,000 Medicare beneficiaries, compared with 44.8 in Hawaii over the same six-year period. The atlas also brings to light significant racial and ethnic disparities. The heart disease hospitalization rate is much higher among blacks (85.3 hospitalizations per 1,000 beneficiaries) than for whites (74.4 per 1,000) or Hispanics (73.6 per 1,000). While these rates declined slowly between 2000 and 2006 for Hispanic and white Americans aged 65 years and older, they remained steady among older black Americans. The atlas also points out geographical differences in access to hospitals with the capability to treat heart disease patients. In 2005, 21 percent of all counties in the United States had no hospital, and 31 percent lacked a hospital with an ER. Specialized cardiac services are even more limited, with 63 percent of U.S. counties lacking a cardiologist outside the Veterans Affairs system.

To learn more about this research, please visit:

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Patient Activation Measure™: How PAM Portends Behavior Change

There are many ways to administer the Patient Activation Measure™ (PAM) and many socioeconomic factors that influence its outcomes, explains Dr. Judith Hibbard, developer of the PAM and professor of health policy at the University of Oregon. Dr. Hibbard identifies the PAM scores that signal a behavior change and the value of adding patient activation assessment to a health improvement initiative.

To listen to this complimentary HIN podcast, please visit:

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Program Takes Collaborative Approach in Caring for the Elderly

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Nora Baratto, manager of case management for St. Peter's Hospital's CHOICES program.

Question: Why was CHOICES, your case management program for older adults, developed, and what are the goals of this program?

Response: We developed the CHOICES program, in part, because of the inappropriate emergency department (ED) use in the 1990s. There is still a great deal of misinformation about where to access care for clients, older adults and family members. Many people think that the ER is still the primary place to access care. We've worked very hard to change this by emphasizing that care should be accessed in a primary care setting. We also looked at our readmission rate, which reflected a high volume of older adults — frequent fliers — who would come in repeatedly. One extremely anxious gentleman who lived alone came in at the same time every night. The system was not meeting his needs, so we looked at how we could take a collaborative, coordinated approach by trying to get everyone on board — the elderly adult as well as their family and community providers.

We also had increased frustration of consumers and primary care providers over accessing healthcare and the appropriate use of resources. For example, many people and families think the Medicare will cover home care. They're surprised and disappointed when they realize that Medicare is short term and intermittent, and they're going to have to use private resources. There's an educational component that goes along with helping them access their care.

The goals of the CHOICES program are to support the client's right to self-determination, assist older adults and families in making informed decisions, to be proactive instead of reactive, reduce readmissions, access the right amount of care at the right time in the right place, and provide superb continuity of care within the St. Peter's Healthcare System.

For more information on managing care transitions for Medicare patients, please visit:

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Addressing Healthcare Challenges of a Multicultural Society

Changing demographics, extensive mobility and upsurges in ethnic diversity present new demands for cultural competency in healthcare. Often, organizations are ill-equipped to handle specific challenges associated with such increases, including surpassing linguistic barriers and paying adequate attention to cultural sensitivities. To that effect, some progressive organizations are implementing diversity training to teach professionals how to better accommodate the needs of an increasingly socially and ethnically stratified population.

To download this complimentary white paper, please visit:

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Midwestern States Receive Least Federal Funding for Disease Prevention

A March 2010 report from the Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) found federal spending for public health has been flat for nearly five years, while states cut nearly $392 million for public health programs in the past year. These cuts leave communities around the country struggling to deliver basic disease prevention and emergency health preparedness services.

States in the Midwest received the least federal funding support for disease prevention at public health, at only $16.50 per person in fiscal year (FY) 2009, according to the analysis. This is $3.30 less per person than Northeastern states, which receive the highest amount, at $19.80 per person. Western states receive $19.22 per person, while Southern states receive $19.75 per person.

States are expected to cut budgets even more in the coming year, which will further limit the ability of public health departments to carry out services for: chronic disease prevention, HIV/AIDS, MRSA, TB, and other infectious disease prevention; food and water safety; environmental health improvement; and bioterrorism and health emergency preparedness.

Other key findings in the Shortchanging America's Health report include that:

  • Federal funding to states from public health from the CDC averaged out to only $19.23 per person in FY 2009. The amount spent to prevent disease and improve health in communities varied significantly from state to state, with a per capita low of $13.33 in Virginia to a high of $58.65 in Alaska. Approximately 75 percent of CDC's budget is distributed through grants or cooperative agreements to states and communities to support programs to prevent diseases and prepare for health disasters.
  • State funding for public health ranged dramatically across the country, from a low of $3.55 per person in Nevada to a high of $169.92 per person in Hawaii. The national median is $28.92 per person. The structure of state and local health departments varies from state to state, with some states relying more on local funds.
To learn more about this research, please visit:

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Medical Homes in 2010

Patient-centered medical home (PCMH) pilots are in high gear around the country and high on the healthcare reform agenda. Recent studies indicate that the PCMH can deliver quality care at little or no added cost. Complete HIN's fourth annual survey on your organization's PCMH experience and get a FREE executive summary of the compiled results. Your responses will be kept confidential.

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

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