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May 20, 2010 Volume VI, No. 51

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

According to the American Stroke Association, about 795,000 Americans each year suffer a new or recurrent stroke, which means that, on average, a stroke occurs every 40 seconds. Since May is American Stroke Month, this week's issue details the importance of educating U.S. women on stroke symptoms and risks, and why some vital stroke treatment is delayed.

Also this week, discover the link between low blood flow to the brain and elderly falls.

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

This week's DM news:

Table of Contents

  1. Calling 9-1-1 for Stroke Symptoms
  2. Elderly Falls & Brain Blood Flow
  3. Reimbursement & Reducing Readmissions
  4. Identifying Case Management Members
  5. Benefit-Based Incentives
  6. 2010 Medical Homes
  7. Stroke Screening
  8. Managing Care Transitions

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People Who Recognize Stroke Symptoms Still May Not Call 9-1-1

People who realize that stroke symptoms are occurring in a family member or friend still may not call 9-1-1 — delaying vital treatment, according to research published in Stroke: Journal of the American Heart Association. Researchers from the Michigan Department of Community Health surveyed 4,814 adults in the state to assess whether they knew when to call for an ambulance when stroke symptoms have been observed. They found that only 14 percent would dial 9-1-1 for three common stroke symptoms and 37 percent reported that they would not call 9-1-1 for any of the stroke symptoms.

Participants were asked to report their first reactions to five hypothetical situations. Three situations — sudden slurred speech, sudden numbness on one side of the body or sudden blurry vision — were symptoms of a stroke. The other two were a high fever or an injured leg, which are not stroke symptoms. The survey didnít include other stroke symptoms, such as sudden trouble walking or severe headache with no known cause. Participants could respond that they would first "give medicine or first aid," "call the doctor," "take them to an ER," "call 9-1-1," "stay with them until they felt better;" or "something else." Calling 9-1-1 was deemed the only correct response. Gender, race, education, household income and insurance status were not significantly related to a personís intent to call 9-1-1.

Additional results showed that:

  • Of the 27.6 percent of participants who knew all three stroke warning symptoms, only 17.6 percent said they would call 9-1-1 for all three stroke symptoms.
  • Fifty-one percent of all respondents would call 9-1-1 for someone having sudden trouble speaking or understanding; 42 percent would call 9-1-1 for someone having sudden numbness or weakness on one side of their body and 20 percent would call for someone who had sudden trouble seeing out of one or both eyes.
  • In four of five of the hypothetical scenarios, taking patients to the ER — not calling for an ambulance — was the most common response.
  • Older people were more likely than younger people to dial 9-1-1 for all three stroke situations — 6.1 percent of those 18- to 24-years-old compared to 17.6 percent of those ages 65 to 74.
The findings indicate a "disconnect" that could be improved with greater public awareness efforts focused on connecting the signs of a stroke with calling emergency medical services (EMS), researchers said. "Respondents appear to be unaware of the advantages of EMS transport, and the fact that public health recommendations advise the use of EMS over private transport. Calling 9-1-1 gets you to the hospital fast and allows the paramedics to communicate with the hospital so staff are prepared for your arrival," said the researchers.

Researchers cautioned against applying these findings broadly to other states. Previous research found that, depending on the stroke symptoms, between 33 and 72 percent of respondents in upstate New York would dial 9-1-1 and between 41 percent and 51 percent of people in Montana would. Itís unclear why people are reluctant to call an ambulance despite being aware of the signs of stroke, said the researchers. Future studies should address possible barriers such as denial, embarrassment, cost and cultural attitudes toward calling for an ambulance.

To learn more about this research, please visit:

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Elderly Falls Linked to Low Blood Flow in Brain

A new study shows that slower than normal blood flow in the brain due to high blood pressure and other conditions may lead to falls in the elderly. Each year, unintentional falls in the United States account for more than 16,000 deaths and 1.8 million ER visits.

For the study, researchers followed 419 people age 65 or older. Ultrasound tests were used to measure participantís blood flow in the brain. Walking speed was measured by a four-meter (13 ft.) walking test. The seniors and their caregivers reported any falls that occurred over two years. The study found that the 20 percent of people who had the slowest rate of blood flow in the brain were at a 70 percent higher risk of falling compared to the 20 percent of people who had the highest rate of blood flow in the brain. Those with the slowest rate had an average of nearly 1.5 falls per year, compared to less than one fall per year for those with the highest rate.

"At age 60, 85 percent of people have a normal walking ability. However, by age 85, only 18 percent of seniors can walk normally," said study author Farzaneh Sorond, M.D., Ph.D., with Harvard Medical School and Brigham and Womenís Hospital in Boston, and a member of the American Academy of Neurology. "Our findings suggest there could be a new strategy for preventing falls, such as daily exercise and using statins and treatments for high blood pressure, since blood pressure affects blood flow in the brain and may cause falls," said Dr. Sorond.

To learn more about this research, please visit:

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Rewards for Reducing Readmissions

Maryland's Hospital Preventable Readmissions program rewards efforts that reduce hospital readmissions while improving care quality and decreasing cost. Dianne Feeney, associate director of quality initiatives for the Maryland Health Services Cost Review Commission (HSCRC), describes HSCRC's response to hospitals that claim they can't afford the empty beds that result from programs like these, as well as processes to help ensure that higher-risk patients are not refused admittance to hospitals. She also explains how partnerships with "siloed settings" — nursing homes and home health providers — can reduce common errors that occur during patient handoffs.

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Identifying Members for Case Management

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is James Hardy, senior vice president of care management services at McKesson Health Solutions.

Question: How are members identified for a primary care case management (PCCM) program and what methodology, if any, is utilized to assign a risk status to individuals with multiple comorbidities? Are members with multiple comorbidities assigned a risk status for more than one DM program?

Response: (James Hardy) In the enhanced PCCM programs in Illinois and Pennsylvania, for example, there is mandatory enrollment of the consumers. They are required to participate in the selection of a PCP and thereís no screening of that in those programs. We use a variety of tools to get at that risk score. It is a cumulative tool that we use primarily inside the business that accumulates the risk score across disease. You will get a higher risk score with a comorbid condition than with a single condition. Itís a proprietary tool, but there are plenty of other tools that are useful in assigning and predicting risk. Johns Hopkins has a good product, and many of the Medicaid agencies also use the Chronic Illness and Disability Payment System (CDPS), which was developed by Richard Kronick, Ph.D., at the University of California at San Diego.

For more information on the comorbid patient, please visit:

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Benefit-Based Incentives

Incentives for health and wellness activities take many forms. We wanted to see how companies are integrating incentives with health insurance benefits.

Click here to view the chart.

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Medical Homes in 2010 — Awareness, Adoption, Tools and Outcomes

Patient-centered medical home (PCMH) pilots are in high gear around the country and high on the healthcare reform agenda. This white paper from the Healthcare Intelligence Network (HIN) measures adoption of the PCMH as compared to our first medical home survey in 2006, the targeted populations that would benefit from this model of care, the components of a medical home and the effects of this model in the healthcare industry.

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Educating U.S. Women on Stroke Symptoms, Risks

Although more than 425,000 women suffer from stroke each year, 55,000 more than men, a new survey showed that women may be dramatically underestimating their risk of this medical emergency, the third leading cause of death in the United States. Only 27 percent of women who were surveyed could name more than two of the six primary stroke symptoms. Moreover, seven out of 10 women who were surveyed said they are not aware they are more likely than men to have a stroke, and were not at all or only somewhat knowledgeable about risk factors. The survey was commissioned by HealthyWomen (HW) in partnership with the National Stroke Association (NSA) and the American College of Emergency Physicians (ACEP).

Educational efforts about understanding stroke and what to do if you experience one may be having an impact. In the survey, 60 percent of women could identify what causes an ischemic stroke, the most common type of stroke, which occurs when a blood vessel that carries oxygen and nutrients to the brain is clogged by a blood clot or other obstruction. Because of this blockage, part of the brain does not receive the blood and oxygen it needs. Eighty-six percent of women knew to call 9-1-1 if they suspected that they or someone near them is experiencing a stroke.

According to the CEO of the National Stroke Association, "Women are twice as likely to die from stroke as breast cancer, however women in the survey believed breast cancer is five times more prevalent than stroke. Furthermore, the survey revealed that 40 percent of women were only somewhat or not at all concerned about experiencing a stroke in their lifetime. The fact is, stroke knows no gender and can happen at any age."

"The results of this survey underscore what we see too often with women when it comes to dealing with their unique health issues. As they put the health of family members and everyone else first, they often underestimate their own risks and ignore warning signs of serious health problems, like stroke," said Elizabeth Battaglino Cahill, RN, HW executive director. "We want to educate women and help empower them to take charge of their health so they not only know how to reduce their risks, but can recognize the tell-tale signs of stroke."

Knowing the six primary symptoms of a stroke is crucial. They include:

  • Sudden numbness or weakness on one side of the face or facial drooping.
  • Sudden numbness or weakness in an arm or leg, especially on one side of the body.
  • Sudden confusion, trouble speaking or understanding speech.
  • Sudden trouble seeing in one or both eyes.
  • Sudden trouble walking, dizziness, loss of balance or coordination.
  • Sudden severe headache with no known cause.
The National Stroke Association recommends the F.A.S.T. test as a quick screening tool that can help individuals identify stroke symptoms:
  • Face — Ask the person to smile. Does one side of the face droop?
  • Arms — Ask the person to raise both arms. Does one arm drift downward?
  • Speech — Ask the person to repeat a simple sentence. Are the words slurred? Can they repeat the sentence correctly?
  • Time — If the person shows any of these symptoms, time is important. Call 911 or get to the hospital. Brain cells are dying.
To learn more about this research, please visit:

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Managing Care Transitions Across Sites

Tighter management of transitions in care — particularly for older adults with complex acute or chronic conditions — can help to close care gaps, avoid unnecessary hospitalizations, readmissions and ER visits, reduce medication errors and raise the bar on care quality. Please join the more than 40 organizations that have shared how they coordinate key care transitions by completing HIN's second annual e-survey on Managing Care Transitions Across Sites by May 31. 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:

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