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March 18, 2010 Volume VI, No. 42

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

Healthy lifestyle changes and timely screenings have contributed to a decline in cancer mortality rates, according to a new study by the American Cancer Society. Learn more about ACS' findings in this week's DM Update, as well as the connection between family history and coronary artery disease. And in our prevention story, discover if the use of medical devices at home could help patients and doctors better manage certain chronic conditions.

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

This week's DM news:

Table of Contents

  1. Cancer Mortality
  2. Coronary Artery Disease & Family History
  3. Heart Failure & Remote Health Monitoring
  4. Health Coaching DM for Beginners
  5. Healthcare Trends: Benchmarks in Health & Wellness Incentives
  6. Managing Diseases with Technology
  7. Medical Homes in 2010

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Cancer Mortality Has Declined Since Initiation of 'War on Cancer'

A new American Cancer Society study found that progress in reducing cancer death rates is evident, whether measured against baseline rates in 1970 or in 1990. The study appears in the open access journal PLos ONE and finds a downturn in cancer death rates since 1990 results, mostly from reductions in tobacco use, increased screening allowing early detection of several cancers and modest to large improvements in treatment for specific cancers.

Temporal trends in death rates are the most reliable measure of progress against cancer, reflecting improvements in prevention, early detection and treatment. Although age-standardized cancer death rates in the U.S. have been decreasing since the early 1990s, some reports have cited limited improvement in death rates as evidence that the “war on cancer,” which was initiated in 1971, has failed. Many of these analyses fail to account for the dominant and dramatic increase in cancer death rates due to tobacco-related cancers in the latter part of the 20th century.

To investigate further, researchers used nationwide cancer mortality data for the years 1970 through 2006 from the SEER*Stat database, which defines major cancer sites consistently over time in order to facilitate reporting of long term mortality trends. They found for all cancers combined, death rates (per 100,000) in men increased from 249.3 in 1970 to 279.8 in 1990, and then decreased to 221.1 in 2006, yielding a relative decline of 21 percent from 1990 (peak year) and a drop of 11 percent since 1970 (baseline year). Similarly, the death rate from all-cancers combined in women increased from 163.0 in 1970 to 175.3 in 1991, and then decreased to 153.7 in 2006, a relative decline of 12 percent and 6 percent from the 1991 (peak year) and 1970 rates, respectively.

The researchers also calculated years of potential life lost (YPLL) due to cancer before age 75 for 2006 as additional measure for the impact of declining cancer death rates on population health. They compared this to the YPLL that would have been expected had the 1970 age-specific cancer death rates continued to apply in 2006. For persons under age 75, the decrease in cancer death rates during the 36 years time interval (1970-2006) resulted in about 2.0 million years of potential life gained.

To learn more about this research, please visit:

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Family History is Predictor of Coronary Artery Disease

In the largest study of its kind to date using cardiac computed tomography angiography, people with a family history of early signs of coronary artery disease (CAD) are at higher risk of developing obstructive CAD and plaque in their arteries, according to Henry Ford Hospital researchers.

"This is the first study to show that family history of premature CAD is a significant predictor of obstructive CAD using coronary computed tomography," says Mouaz Al-Mallah, M.D., director of Cardiac Imaging Research at Henry Ford and lead author of the study. "Based on past research and our findings, we believe cardiac computed tomography angiography would likely identify a high risk group of patients with advanced plaque buildup."

The researchers analyzed data from more than 8,200 patients who underwent cardiac computed tomography angiography, a diagnostic imaging tool that looks at the coronary arteries and evaluates the amount of blockage from plaque, and found that those with a family history of CAD have a 28 percent chance of developing the disease themselves than those with no family history. Family history of CAD also was independently associated with an increased prevalence of plaque in the arteries. While family history is a well-known risk factor for premature CAD, Henry Ford researchers examined whether family history was also linked to obstructive CAD in patients who underwent cardiac computed tomography angiography. For the study, the researchers analyzed data of patients using the Advanced Cardiovascular Imaging Consortium, which is funded by Blue Cross Blue Shield of Michigan.

Premature coronary artery disease occurs in people 45 and under. As a person ages, the coronary arteries are more likely to narrow and harden, leading to obstructive coronary artery disease, the leading cause of death in the United States for men and women. Every year, more than 500,000 Americans die from coronary artery disease.

To learn more about this research, please visit:

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Reducing Heart Failure Admissions through Remote Health Monitoring

Remote monitoring of heart failure patients by Henry Ford Health System reduced expected all-cause hospital admissions for enrollees by 36 percent after six months of enrollment and a return of 2.3:1 vs. program costs, according to a September 2009 study. Dr. Randall Williams, CEO of Pharos Innovations, the developer of the Tel-Assurance(R) remote patient monitoring platform used in Henry Ford's medical home pilot, describes how the daily engagement of Medicaid beneficiaries in self-care health monitoring programs can help healthcare organizations avoid many of the challenges inherent in working with this frequently underserved population. Once participants are identified, they are very receptive to the daily contact, which has resulted in extremely high program engagement rates.

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Health Coaching DM for Beginners

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Roger Reed, chief consumer engagement architect for Gordian Health Solutions.

Question: If you were a hospital with 4,000 employees, and you had one on-site health coach, where would you start? Would you start with DM, chronic DM or more general health coaching for lifestyle?

Response: My bias is toward the lifestyle, keeping the healthy healthy, and then working up into the low- and moderate-acuity individuals with conditions that would benefit from lifestyle improvement. Then I’d probably focus on the disease states toward the end because if you look at the data around DM, it appears from the data to be more effective when handled by the physician in their office. I would really push individuals toward their physicians.

For more information on DM and lifestyle health coaching, please visit:

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Healthcare Trends & Studies: 2010 Benchmarks in Health & Wellness Incentives Use

The use of economic incentives to drive engagement and results from wellness and prevention programs continues to proliferate. This executive summary captures responses of 139 healthcare organizations to HIN's second annual Health and Wellness Incentives Use e-survey administered in February 2010 on the focus, utilization and impact of health and wellness incentives, from types of incentives offered to methods for identifying individuals for incentive programs and reasons for providing incentives.

To download this complimentary white paper, please visit:

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At-Home Health Devices May Benefit Chronic DM

The use of at-home medical devices to connect doctors and patients via the Internet can help patients and their physicians work more efficiently together to manage chronic conditions, according to research at Cleveland Clinic. In December 2008, Cleveland Clinic and Microsoft collaborated on a pilot project that pairs the hospital's EMRs system with the software company's online HealthVault service to monitor patients' health conditions. HealthVault is a security-enhanced, Web-based data storage platform for patients. More than 250 participants enrolled — 26 percent with diabetes, 6 percent with heart failure and 68 percent with hypertension — making it the first physician-driven pilot project in the country to follow multiple chronic diseases in a clinical setting. Nearly half of all Americans are now diagnosed with at least one chronic condition, accounting for 75 percent of nation’s healthcare spending.

In the Cleveland Clinic-Microsoft pilot project, participants used at-home heart rate monitors, glucometers, scales, pedometers or blood pressure monitors, depending on each patient’s disease. These devices uploaded the patient’s data to HealthVault, which then connected to the patient’s personal health record (PHR) at Cleveland Clinic (MyChart, by Epic Systems) and the EMR system used by the patient’s healthcare providers at Cleveland Clinic (MyPractice, also by Epic Systems).

The project found a significant change in the average number of days between physician office visits for patients. Diabetic and hypertensive patients were able to make doctor’s office visits less often, increasing the number of days between appointments by 71 percent and 26 percent respectively, indicating that patients had better control of their conditions. Heart failure patients, however, visited their doctors more often, decreasing the number of days between visits by 27 percent, indicating that patients were advised to see their healthcare provider in a more timely manner. According to Randall C. Starling, M.D., M.P.H., section head of heart failure & cardiac transplant medicine at Cleveland Clinic, “when treating heart failure patients, timely intervention is crucial when complications arise, so that we can prevent serious problems that may require ER visits or readmissions. The ability to monitor weight, blood pressure and activity levels of heart failure patients on a regular basis ensures more timely doctor visits and avoidance of more expensive interventions."

With the use of coordinated secure health information technologies, some healthcare activities that have traditionally occurred only in a physician's office might one day occur wherever a patient may be, including at home or at work. “Making it easier for patients to more actively engage in their ongoing health and wellness is a necessary step in trying to manage the increasing onset of chronic disease worldwide and the costs associated with this alarming trend,” said Peter Neupert, corporate vice president, Microsoft Health Solutions Group. "The results of this pilot are promising and demonstrate how cost-effective and flexible technology solutions can support patients in better monitoring their chronic conditions from where they live and work."

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. Nearly 80 organizations have responded so far; your responses will be kept confidential.

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

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