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July 1, 2010 Volume VI, No. 57

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

Schools are now trying to reduce a child's risk for type 2 diabetes by providing different interventions, which can be found in this week's issue. Also detailed are tests to predict falls in Parkinson's patients and reasons why many breast cancer patients are not adhering to their treatments.

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

This week's DM news:

Table of Contents

  1. Breast Cancer Treatment Adherence
  2. Predicting Falls in Parkinson’s Disease
  3. Physician Practices & Medical Homes
  4. Promoting Health Improvement Programs
  5. Tactics to Prevent Readmissions
  6. Benchmarks in Medication Adherence
  7. School Interventions for Diabetes
  8. Reducing Avoidable ER Visits

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Six Reasons for Treatment Non-Adherence in Breast Cancer Patients

A study of nearly 8,800 women with early-stage breast cancer found that fewer than half — approximately 49 percent — completed their full regimen of hormone therapy according to the prescribed schedule. Investigators found that younger women were particularly likely to discontinue treatment. The findings underscore the need to both better understand the reasons behind such treatment non-compliance and also develop interventions to reduce it.

According to researchers, there are several possible reasons for halting therapy early, noting that 13 percent of the women delayed getting their first prescription refilled. These factors can include the side effects of the therapy, such as joint pain, hot flashes or fatigue, a lack of understanding of the benefit of the therapy, and high costs of medications and/or insurance co-payments.

While up to five years of oral hormone therapy (such as tamoxifen and aromatase inhibitors) for hormone-sensitive breast cancers is frequently prescribed to reduce the risk of cancer recurrence and death, some previous small studies indicated that only approximately 40 to 60 percent of women finish their recommended course of therapy. In order to provide a more comprehensive perspective, researchers examined automated pharmacy records of 8,769 women diagnosed with stage I, II or III hormone-sensitive breast cancer between 1996 and 2007. They used the records to identify hormonal therapy prescriptions and refill dates. Each woman filled at least one prescription for hormonal therapy within one year of diagnosis. Women used tamoxifen (43 percent), aromatase inhibitors (26 percent) or both (30 percent).

The researchers found that women under age 40 had the highest risk of discontinuing therapy early. By 4.5 years, 32 percent of all patients in the study had stopped taking their hormone therapy, and of those who did not stop, only 72 percent finished on schedule (meaning they took their medication more than 80 percent of the time). They found that in women younger than 40 and older than 75, those who had lumpectomy as opposed to mastectomy and those with other medical illnesses were more likely to discontinue hormonal therapy early. Asian/Pacific Islander ethnicity, a history of prior chemotherapy, being married and longer prescription refill intervals were associated with completing 4.5 years of hormonal therapy. Longer refill intervals meant fewer chances to not refill prescriptions.

To learn more about this research, please visit:

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Tests Help Predict Falls in Parkinson’s Disease

A group of tests may help predict which people with Parkinson’s disease are more likely to fall, according to a study published in an issue of Neurology®, the medical journal of the American Academy of Neurology. For the study, 101 people with Parkinson’s disease who were able to walk without any aids took a variety of tests evaluating their Parkinson’s symptoms, balance and mobility. The participants then reported any falls that occurred over a six-month period.

Most participants were in the early stage of the disease, with an average of six years since the disease was diagnosed. The majority of the participants (77 percent) had the type of Parkinson’s that is mainly affected by difficulty with voluntary movements, while 20 percent had tremors as the central symptom of the disease. A total of 48 percent of the participants had a fall during the study and 24 percent had more than one fall. A total of 42 percent reported that they had fallen in the year before the study started.

The tests that were the best predictors of whether a person was likely to fall included a test of overall Parkinson’s symptoms, a questionnaire on how often people tended to “freeze” while walking, and a test of balance. When these tests were combined, the results produced a sensitivity (percentage of actual positives that are correctly identified as positive) of 78 percent and a specificity (percentage of negatives that are correctly identified) of 84 percent for predicting falls.

To learn more about this research, please visit:

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Recruiting Physician Practices for a Medical Home Pilot

As more payors test the patient-centered medical home model of care, what are the pros and cons of participation for physician practices? Dr. Marjie Harbrecht, medical and executive director of Health TeamWorks, describes the financial middle ground that is likely to satisfy payors and providers who sign on for medical home pilots and offers some additional selection criteria her organization (formerly the Colorado Clinical Guidelines Collaborative) may use in the future.

To listen to this complimentary HIN podcast, please visit:

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Promoting Health Improvement Programs

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's experts are Ethan Bird, community educator for Florida Hospital Zephyrhills at Adventist Health Systems, and Bob Kamieneski, administrative director for Florida Hospital Zephyrhills at Adventist Health Systems.

Question: How did you promote your health improvement program and did you offer any incentives?

Response: (Ethan Bird) Identifying members for L.I.F.E. — our health improvement program comprised of a tobacco-free initiative, a healthy BMI initiative and a physical activity initiative — was an easy task. We advertised in the hospital, through the Intranet, in the employee magazine, on employee bulletin boards and in employee lounges across the campus. We do a media hit to raise awareness. Once word gets out of the program and its cash incentives, it then takes on a life of its own. The program opens enrollment for one month, twice a year.

Florida Hospital Zephyrhills conducts an assessment every six months to measure members’ activities in the L.I.F.E. Program. At this assessment, participants’ weights and BMIs are recorded for those participating in the healthy BMI program. Those participating in the tobacco-free program will sign an affidavit stating they have been tobacco-free for the previous six-month period. And those participating in the physical activity component of the L.I.F.E. Program complete and turn in an exercise journal to measure their improvement.

(Bob Kamieneski) Cash incentives seem to do the trick for the L.I.F.E. Program. Other wellness programs that Florida Hospital Zephyrhills offers give out T-shirts, mugs and other such trinkets, but the cumulative $1,000 per year incentive among the healthy BMI, physical activity and tobacco-free components has proven most successful. Before the L.I.F.E. Program, Florida Hospital Zephyrhills had a number of wellness components, including a stress management program, an employee fitness center and various community education and health programs. Often, employees sign up for the community programs as well.

Because these programs were already in place and wellness and fitness are part of the culture at Florida Hospital Zephyrhills, there was not much resistance or challenges to rolling out the L.I.F.E. Program. The biggest issue Florida Hospital Zephyrhills faced when rolling out the L.I.F.E. Program was with the healthy BMI component. Participants were only rewarded the $350 cash incentive if they fell into “normal BMI” categories, yet those who did in fact lose BMI points but were still “overweight” or “obese” received no reward.

To learn more about health improvement programs for weight management, please visit:

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Top 13 Tactics to Prevent Readmissions

To avoid leaving reimbursement money on the table, healthcare organizations are working hard to reduce avoidable rehospitalizations, especially among Medicare patients. We wanted to identify the top strategies for reducing readmissions.

Click here to view the chart.

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2010 Benchmarks in Medication Adherence Programs

Beyond increasing risk of death, poor medication adherence is tied to as much as $290 billion annually in increased medical costs and responsible for 33 to 69 percent of all medication-related hospital admissions in the United States, at a cost of about $100 billion per year. This white paper from the Healthcare Intelligence Network captures the efforts of 107 healthcare companies to improve medication adherence in their populations, from targeted populations and conditions of medication adherence programs to the components of a successful medication adherence program, as reflected by their responses to the January 2010 Medication Adherence e-survey.

To download this complimentary white paper, please visit:

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School-based Interventions Cut Type 2 Diabetes Risk in Children

Rates of type 2 diabetes, a disease once only found in adults, have been steadily rising in children for years. If unchecked, it can have serious health effects for children, including higher risks of heart and blood vessel disease, nonalcoholic fatty liver disease, skin problems and damage to the nerves, kidneys, eyes and feet. But a national study has found that school-based interventions can help reduce various risk factors for type 2 diabetes in children. The HEALTHY study was a three-year, nationwide study that assessed the effects of a school-based approach to preventing risk factors for type 2 diabetes among more than 4,600 students in grades 6-8 from 42 middle schools. Half of the schools were intervention schools that followed HEALTHY's guidelines for activity levels and food offerings in cafeterias, vending machines and at school events, and the other half of schools acted as the controls.

Each intervention school provided its students with:

  • Healthier food choices that were high in fiber and low in fat.
  • More fruits and vegetables.
  • Water or low-fat milk.
  • A minimum of 225 minutes of physical education class every 10 days.
  • Communication campaigns and educational programs that promoted long-term healthy behaviors.
Rates of type 2 diabetes are much higher among minorities and low-income populations, which is why the HEALTHY study was conducted in schools with predominantly Hispanic and African-American children from low-income households — most of whom were eligible for free or reduced-priced lunches.

Researchers said that by the end of the study there was a 4 percent reduction in the combined rates of overweight and obesity at both intervention and control schools. While pleased with the unexpected finding, they noted that further analyses will need to be done to determine why the rates of overweight and obesity also improved in control schools. Despite similar decreases in the combined rates of overweight and obesity in intervention and control schools, children in intervention schools had greater reductions in obesity, BMI z-scores (BMI that is closer to the norm for a child's age and gender), waist circumference measurements and fasting insulin levels than did children in control schools.

To learn more about this research, please visit:

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Reducing Avoidable Emergency Room Visits

Inappropriate and preventable use of the hospital emergency department is a nationwide problem and a serious drain on healthcare resources. Many healthcare organizations have launched programs to reduce avoidable use of the hospital ER. Complete this month's survey on reducing unnecessary emergency room visits by July 31, 2010 and we will e-mail you a copy of the compiled survey results in August.

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

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