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April 8, 2010 Volume VI, No. 45

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

In this week's issue, learn about a retail clinic now offering health monitoring services for certain conditions, as well as gender differences in exercise by cardiac patients. You will also discover the risks that diabetes can pose in patients needing cancer surgery.

In addition, get the latest metrics in obesity and weight management by completing our new e-survey by April 30. Tell us what your organization is doing to reduce obesity.

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

This week's DM news:

Table of Contents

  1. Heart Health & Exercise Adherence
  2. Diabetes & Cancer Surgery
  3. Healing and Spirituality in Coaching
  4. PCP Follow-up in Retail Clinics
  5. Health Coaching Case Load
  6. Telehealth & Care Access
  7. Health Condition Monitoring Service
  8. Obesity and Weight Management 2010

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

Melanie Matthews, mmatthews@hin.com

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Study Finds Poor Exercise Adherence After Cardiac Event

Researchers from the Frances Payne Bolton School of Nursing at Case Western Reserve University found that one year after 248 individuals completed a 12-week cardiac rehabilitation program following a heart attack, bypass surgery or angioplasty, only 37 percent exercised three times a week to keep their hearts healthy. Women across the age groups were less inclined to make the healthy changes in comparison to men. Although all groups had a decline between months 9 and 12, younger men sustained healthy exercise patterns better than all the other groups. This research follows up on an assessment of individuals as they left a 12-week rehabilitation program to help cardiac patients make lifestyle changes in the area of exercise — a major factor in improving heart health.

Both studies are projects of the SMART (Self-Management Advancement through Research Translation) Center, a National Institute of Nursing Research/National Institute of Health-funded center of excellence to build the science of self-management. This study is part of a longitudinal look at how people manage their chronic illnesses. The researchers said that the new research study examined gender differences in three age groups: 60 years and younger, 61 to 71 years and people older than 71. Exercise patterns were recorded through heart monitors worn by the participants. The study found that across the age groups, women exercised less than men, and that the oldest group of men exercised less than younger men.

What might contribute to the decline in exercise over time for women is the initial optimistic outlook that exercise barriers, like caregiving for family members, can be overcome. However, these barriers in fact prevent women in time from continuing an exercise program. According to the researchers, patients may need new interventions to realize that this is a necessary lifelong change.

To learn more about this research, please visit:

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Diabetes Raises Death Risk in Cancer Surgery Patients

People with diabetes who undergo cancer surgery are more likely to die in the month following their operations than those who have cancer but not diabetes, an analysis by Johns Hopkins researchers suggests. The study finds that newly diagnosed cancer patients — particularly those with colorectal or esophageal tumors — who also have Type 2 diabetes have a 50 percent greater risk of death following surgery. Roughly 20 million Americans — about 7 percent of the population — are believed to have diabetes and the numbers continue to grow.

The risk picture presented by the researchers emerged from a systematic review and meta-analysis of 15 previously published medical studies that included information about diabetes status and mortality among patients after cancer surgery. The size of the studies ranged from 70 patients to 32,621 patients, with a median of 427 patients. The researchers stated that the analysis could not say why cancer patients with diabetes are at greater risk of death after surgery. One culprit, though, could be infection; diabetes is a well-established risk factor for infection and infection-related mortality in the general population, and any surgery can increase the risk of infections. Another cause may be cardiovascular compromise. Diabetes raises the risk of atherosclerosis and is a strong predictor of heart attack and death from cardiovascular disease.

This study is part of a growing volume of research under way at the intersection of diabetes and cancer, two leading causes of death in the U.S. Diabetes appears to increase risk for some types of cancer, and risk factors such as physical inactivity, unhealthy lifestyles and obesity are believed to be shared by both diseases.

To learn more about this research, please visit:

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Integrating Healing and Spirituality into Health Coaching

The definition of community in an individual's change process is unique to that individual, explains Dr. Karen Lawson, program director for the health coaching track at the Center for Spirituality and Healing, the University of Minnesota. In this interview, Dr. Lawson discusses healing and spirituality within the framework of a health coaching exchange and the appropriate moments for a coach to broach these subjects. While a health coach cannot be an expert in all available therapies, the coach can be a "curious explorer" who "dips their toes" into alternative health therapies and systems along with the client.

To listen to this complimentary HIN podcast, please visit:

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PCP Follow-up in Retail Clinics

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Dr. Thomas Atkins, medical director of Sutter Express Care, drugstore-based medical clinics in Sutter Health’s network of hospitals and doctors serving Northern California.

Question: What kind of follow-up is the primary care physician (PCP) doing from retail clinic visits?

Response: We work closely with our PCPs. We have a physician referral list from our network of physicians who are taking new patients. If a patient presents something to us that is out of scope, we’ll design a treatment plan along with a nurse practitioner (NP), and we’ll get the order started. For example, if somebody comes in who is thought to have pneumonia, they’ll start the antibiotics, order the chest X-ray and the lab work, and make a follow-up appointment with a PCP so that when that patient comes to them, they have some clinical data to work with. We try to position it in that way. If a patient who is seen by our own physicians has a problem that seems to be out of scope, we have an implicit guarantee. If we see a patient who’s out of scope and we can’t treat them, we don’t charge them. If the visit initially looks to be in scope, but through the course of the assessment it looks like they’re out of scope and they do have a referral source, then we’ll send the patient over to the physician or an urgent care center to see them. We have an escalating tier of places we’ll send them depending on their acuity, up to the ER.

For more information on retail clinics, please visit:

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Telephone Connectivity Supports Medical Home Model and Removes Barriers to Care

This white paper articulates the value of telehealth — namely the utilization of the telephone to provide physician or consumer-directed cross coverage 24/7 — as an emerging and effective application in tackling specific issues related to episodic care as well as chronic care management for diseases such as diabetes, cancer and cardiac disease.

To download this complimentary white paper, please visit:

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MinuteClinic Offers New Health Condition Monitoring Services

MinuteClinic is now offering a series of convenient health condition monitoring services to help patients previously diagnosed with diabetes, asthma, high cholesterol and high blood pressure overcome the challenges of living with their conditions. Health condition monitoring is available at MinuteClinic locations in CVS/pharmacy stores in 20 states and the District of Columbia.

The new monitoring services, called Monitoring Made Easy™, are performed by MinuteClinic NPs and physician assistants. They are designed to support patients with ongoing health conditions in between visits to their PCP or to provide assistance to patients who may not receive regular care. MinuteClinic will send all healthcare monitoring results to a PCP with patient permission. Visit summaries are sent via EMRs or fax, typically within 24 hours. In addition, MinuteClinic practitioners will help patients locate a PCP in the community if they do not have one. A collaborating physician (medical director) is on call during MinuteClinic operating hours. Monitoring Made Easy services at MinuteClinic are available seven days a week, including weekday evening hours without an appointment.

When providing health condition monitoring services, MinuteClinic practitioners review the individual's medical history and perform an exam and tests based on nationally established clinical practice guidelines for standards of care, which may include an A1c test and comprehensive foot exam for diabetes, breathing and oxygen level testing for asthma, a lipid profile for high cholesterol and a blood pressure check and microalbumin test for high blood pressure. A series of blood pressure, high cholesterol, diabetes and weight evaluation screening services are also provided by MinuteClinic to patients who have not been previously diagnosed with a condition but want to determine if they are at risk.

To learn more about this research, please visit:

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Obesity and Weight Management 2010

Despite early indicators of success on the management front, obesity is still tied to an estimated $117 billion in healthcare costs. New healthcare reform will reward prevention-related initiatives, and first lady Michelle Obama's Let's Move campaign hopes to solve the childhood obesity epidemic within a generation. Describe how your organization is working to prevent and reduce obesity and related conditions and costs in your population by taking the Obesity and Weight Management survey by April 30. You'll receive a free e-summary of the results, and your responses will be kept strictly confidential.

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

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