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June 24, 2010 Volume VI, No. 56

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

This week's issue invites you to "eat, drink and be healthy" by discovering the health benefits of certain foods and beverages in relation to diabetes and heart health.

And let's not forget the importance of exercising and eating healthy to decrease childhood obesity risk. Learn how a child's neighborhood could prevent such a reduction.

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

This week's DM news:

Table of Contents

  1. Reducing Diabetes Risk with Brown Rice
  2. Childhood Obesity & Neighborhoods
  3. Improving Diabetes Care
  4. Stress Management Coaching
  5. Medical Home Transformation
  6. Connecting with DM Clients
  7. Coffee, Tea Benefit Heart Health
  8. HRAs

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

Melanie Matthews, mmatthews@hin.com

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Replacing White Rice with Brown May Reduce Diabetes Risk

Researchers from the Harvard School of Public Health (HSPH) have found that eating five or more servings of white rice per week was associated with an increased risk of type 2 diabetes. In contrast, eating two or more servings of brown rice per week was associated with a lower risk of the disease. The researchers estimated that replacing 50 grams of white rice (just one third of a typical daily serving) with the same amount of brown rice would lower risk of type 2 diabetes by 16 percent. The same replacement with other whole grains, such as whole wheat and barley, was associated with a 36 percent reduced risk. The study is the first to specifically examine white rice and brown rice in relation to diabetes risk among Americans.

The researchers examined white and brown rice consumption in relation to type 2 diabetes risk in 157,463 women and 39,765 men participating in the Brigham and Women’s Hospital-based Nurses’ Health Study (NHS) I and II and the Health Professionals Follow-up Study (HPFS). The researchers analyzed responses to questionnaires about diet, lifestyle and health conditions which participants completed every four years. They documented 5,500 cases of type 2 diabetes during 22 years of follow-up in NHS I participants, 2,359 cases over 14 years in NHS II participants and 2,648 cases over 20 years in HPFS participants.

It was found that the biggest consumers of white rice were less likely to have European ancestry or to smoke and more likely to have a family history of diabetes. Eating brown rice was not associated with ethnicity but with a more health-conscious diet and lifestyle. In the analysis, researchers adjusted for a variety of factors that could influence the results, including age, BMI, smoking status, alcohol intake, family history of diabetes and other dietary habits, and found that the trend of increased risk associated with high white rice consumption remained. Because ethnicity was associated with both white rice consumption and diabetes risk, the researchers conducted a secondary analysis of white participants only and found similar results.

Because brown rice consumption was low in the study population, the researchers could not determine whether brown rice intake at much higher levels was associated with a further reduction in diabetes risk. Substitution of other whole grains for white rice was more strongly associated with lowering diabetes risk. This observation, said the researchers, may result from more reliable estimates based on participants’ higher consumption of whole grains other than brown rice.

To learn more about this research, please visit:

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Childhood Obesity Linked to Neighborhood Social, Economic Status

Children in King County, Washington are more likely to be obese if they live in socially disadvantaged neighborhoods, according to researchers at Seattle Children's Research Institute, the University of Washington (UW) and Group Health Research Institute.

The research team collected anonymous, "de-identified" EMR information on 8,616 children ages 6–18 receiving care at Group Health Cooperative — and then correlated these data to the social and economic characteristics of Seattle-area census tracts. The researchers found obesity most common in children living in neighborhoods with the least-educated females, most single-parent households, lowest median household income, highest proportion of non-white residents and fewest homes owned. Together, these five socioeconomic factors accounted for 24 percent of the variability in childhood obesity rates across neighborhoods.

Disadvantaged neighborhoods may present many obstacles for children’s weight, such as less access to healthy foods and more unhealthy fast-food outlets. They also often lack safe places for children to play outdoors. The likelihood of childhood obesity rose by 17 percent to 24 percent for each of three measures of neighborhood social disadvantage: each 10 percent decrease in female education and two-parent households, and each $10,000 decline in household income. Effects related to race and homeownership were smaller but still statistically significant.

This study of childhood obesity helped overcome the limitations of previous studies by using weight measurements pulled from medical records, not self-reported by study subjects. Self-reporting is often less accurate. This was the first study evaluating childhood obesity to use rigorous statistical methods of spatial modeling to smooth out differences based on arbitrary census tract lines. Using this technique helped provide a more accurate effect of neighborhoods on children’s weight.

To learn more about this research, please visit:

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DM Collaboration Improves Diabetes Care

A unique data exchange between the largest insurer in New Jersey and an 850-physician organization resulted in a member-specific profile for each diabetes patient accessible at the point of care. Partners in Care Medical Director Dr. James Barr describes the fine points of the one-year pilot that joined the DM efforts of Horizon Blue Cross Blue Shield of New Jersey with those of Partners in Care physicians to dramatically improve compliance levels and clinical outcomes for patients with diabetes.

To listen to this complimentary HIN podcast, please visit:

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Coaching on Stress Management

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's experts are Darcy Hurlbert, formerly a health and wellness product specialist at Ceridian LifeWorks, and Sean Slovenski, CEO and president of Hummingbird Coaching Services.

Question: What resources and training would you recommend for teaching health coaches how to coach participants on stress management?

Response: (Darcy Hurlbert) We have a coach who we use as our internal expert. She has gone through training, such as attending different workshops and reading different books. Finding someone who has a passion for stress management has been our best resource. Also, since Ceridian has an EAP background, we are able to leverage the skills of the EAP consultants and the resources they have in dealing with day-to-day stress management issues as a resource.

(Sean Slovenski) We have our own internal experts and our health coaching product. There are five core areas we health coach people about, whether they have a diagnosis, chronic disease state or are beginner marathon runners: exercise, nutrition, weight management, stress management and smoking cessation. In each of those areas, we have an internal expert looking at the latest research and techniques from different institutions on stress management. We draw much of our research from the area of positive psychology of managing stress, and using character strengths to focus on solving problems. They are usually the ones who are pulling all the latest information together and adding new training modules or skill-builders for our staff.

For more recommendations on training health coaches in certain areas, please visit:

We want to hear from you! Submit your question for Disease Management Q&A to info@hin.com.

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Time Needed for Medical Home Transformation

Patient-centered medical home (PCMH) pilots are in high gear around the country and high on the healthcare reform agenda. We wanted to see how long it takes a physician practice to transform itself into a full patient-centered medical home.

Click here to view the chart.

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Connecting with Hard-to-Reach DM Clients

Locating and initiating contact with members is a challenge that many organizations face when administering DM programs to the medically underserved. HIN conducted a non-scientific online survey where 67 organizations — including hospitals, physician organizations and health plans — shared how they deal with hard-to-reach clients.

To download this complimentary white paper, please visit:

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Coffee and Tea Benefit Heart Health

High and moderate consumption of tea and moderate coffee consumption are linked with reduced heart disease, according to a study published in Arteriosclerosis, Thrombosis, and Vascular Biology: Journal of the American Heart Association. The researchers used a questionnaire to evaluate coffee and tea consumption among 37,514 participants. They followed the participants for 13 years for occurrences of cardiovascular disease and death.

Researchers found that for tea:

  • Drinking more than six cups of tea per day was associated with a 36 percent lower risk of heart disease compared to those who drank less than one cup of tea per day.
  • Drinking three to six cups of tea per day was associated with a 45 percent reduced risk of death from heart disease, compared to consumption of less than one cup per day.
For coffee it was found that:
  • Coffee drinkers with a modest intake — two to four cups per day — had a 20 percent lower risk of heart disease compared to those drinking less than two cups or more than four cups.
  • Although not considered significant, moderate coffee consumption slightly reduced the risk of heart disease death and deaths from all causes.
Researchers also found that neither coffee nor tea consumption affected stroke risk. "While previous studies have shown that coffee and tea seem to reduce the risk of heart disease, evidence on stroke risk and the risk of death from heart disease was not conclusive," according to researchers. "Our results found that the benefits of drinking coffee and tea occur without increasing risk of stroke or death from all causes." Researchers suggest that the cardiovascular benefit of drinking tea may be explained by antioxidants. Flavonoids in tea are thought to contribute to reduced risk, but the underlying mechanism is still not known.

To learn more about this research, please visit:

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Aggregate data from health risk assessments (HRAs) provides a roadmap for healthcare organizations to deliver health promotion and disease management interventions to targeted individuals — with the goal of improving clinical and financial outcomes. Join the 107 organizations that have already completed our survey on HRAs and get a FREE executive summary of the compiled results.

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

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