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July 29, 2010 Volume VII, No. 4

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

Prolonged time spent sitting can increase the risk of death and certain diseases, according to a new study from the American Cancer Society. Discover in this issue how simply getting up and moving around can prevent certain diseases. Also, learn why clinicians want more details in cancer research reports and the link between breast cancer and African ancestry.

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

This week's DM news:

Table of Contents

  1. Breast Cancer & African Ancestry
  2. Cancer Research Needs Details
  3. DM & Healthcare Continuum
  4. The Insights-Action Connection
  5. Depression Screening Tools
  6. Health & Wellness Incentives Use
  7. Disease Prevention & Time Sitting
  8. Reducing Avoidable ER Visits

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

Publisher:
Melanie Matthews, mmatthews@hin.com

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Study Links African Ancestry to High-Risk Breast Cancer

A new study finds that African ancestry is linked to triple-negative breast cancer, a more aggressive type of cancer that has fewer treatment options. Researchers at the University of Michigan Comprehensive Cancer Center found that, among women with breast cancer, 82 percent of African women, 26 percent of African-Americans and 16 percent of white Americans were all triple negative. Triple negative breast cancer is negative for three specific markers that are used to determine treatment: the estrogen receptor, the progesterone receptor and HER-2/neu.

The study looked at 581 African American women and 1,008 white women diagnosed with breast cancer at the Henry Ford Health System in Detroit, plus 75 African women diagnosed at the Komfo Anokye Teaching Hospital in Ghana. Researchers found that Ghanaian women were diagnosed at a younger age than American women, and with larger tumors and more advanced cancer. In addition, the Ghanaian women were more likely to test negative for each of the three markers.

Prior studies have shown that while African-American women are less likely than white women to develop breast cancer, those who are diagnosed are usually younger and are more likely to die from the disease. These characteristics, including the triple negative disease, are also more common among women with a known hereditary predisposition for breast cancer related to BRCA1 gene mutations. Other studies have also shown a hereditary breast cancer risk associated with racial-ethnic identity — most commonly among Ashkenazi Jewish women.

To learn more about this research, please visit:
http://www2.med.umich.edu/prmc/media/...

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Cancer Research Reports Need to Include More Clinical Details

How information from cancer research trials are reported in scientific journals may impact how quickly new treatments become therapies that can benefit human health. Only 11 percent of 262 scientific articles had all of the information clinicians say is needed to prescribe and monitor new cancer therapies for their patients, according to University of Florida (UF) researchers.

Investigators asked a separate, multidisciplinary group of cancer clinicians to identify the minimum information necessary to use a scientific report to guide clinical care. The list included such clinically important items as the name of the drug and how it was administered. The team then analyzed 262 reports published from 2005 to 2008 in the Journal of Clinical Oncology, The New England Journal of Medicine, the Journal of the National Cancer Institute, and the journals Cancer and Blood.

Overall, the journals presented 73 percent of this minimum information required, ranging from 71 percent in Cancer to 80 percent in the Journal of the National Cancer Institute. The Journal of Clinical Oncology, which published 63 percent of the studies analyzed, carried 73 percent of the information needed. While the dose of the drug was almost always reported, only 43 percent of the papers reported what kind of premedication was necessary, and only 42 percent reported how to adjust dosages if the therapy proved toxic. Only 11 percent of the papers were complete in their inclusion of all minimum information required.

The UF researchers called on the scientific community to develop detailed guidelines that ensure clinical trial reports can be used in a clinical setting, comparable to existing guidelines that ensure the scientific accuracy and merit of such reports. Such measures would be in line with goals set by the National Institutes of Health to speed therapies to the public.

To learn more about this research, please visit:
http://news.ufl.edu/2010/07/15/cancer-3/

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The Strategic Ongoing Role of DM in the Healthcare Continuum

Nightly data mining has helped Vanderbilt University and Medical Center make contact with high-risk high-volume patients, explains Dr. Dexter Shurney, which has vastly improved patient outcomes and closed care gaps. But the medical director of Vanderbilt's Employee Health and Care Plan would like to see even more data put in front of physicians at the point of care — especially regarding certain patients with no claims history. Dr. Shurney describes these "bombs waiting to explode," as well as the impact of the patient-centered medical home (PCMH) model of care on DM and why wellness and prevention services may be the best responses to individuals with comorbidities.

To listen to this complimentary HIN podcast, please visit:
http://www.hin.com/podcasts/podcast.htm#85

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The Insights-Action Connection

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's experts are Kate Larsen, president of Winning LifeStyles, Inc., an ICF-certified professional coach and a Wellcoaches faculty member and mentor coach; and Claudine Reilly, wellness manager at CVS Caremark, certified intrinsic coach and certified health education specialist.

Question: In order to achieve health behavior change, the client needs insight followed by action. How do you encourage the action?

Response: (Kate Larsen) Depending upon the insight, the question might be, "So how could you start to address that?" or "What could you do to begin that change?" or "How could you add that into your life?" Often it might be the first time someone says, "If I were to exercise, I would feel better and then I would be better with the kids. I would be better at work...I really need to exercise." The question might be, "Where will you start?" And I used the word "will" very intentionally, not where "can" you start. I want to start with "will" to see their level of commitment to that comment.

(Claudine Reilly) One of the ways I always end a coaching conversation is by asking, "What would you like to take away today?" Usually they have already framed that as their goal for the week. Or perhaps I say, "What would you like to work on until we meet again?" It is asking them for their own goals until we meet again.

For more information on encouraging engagement in coaching, please visit:
http://store.hin.com/product.asp?itemid=3933

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

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There are other free email newsletters available from HIN!

Medical Home Monitor tracks the construction of medical homes around the country and their impact on healthcare access, quality, utilization and cost. As providers and payors reframe care delivery, this twice monthly e-newsletter will cover the pilots, practice transformations, tools and technology that will guide healthcare organizations toward clinical excellence.

To sign up for our free email newsletters, please visit:
http://www.hin.com/freenews2.html

Top Depression Screening Tools

Patients with major depression are three times more likely to disregard treatment recommendations. We wanted to find out which screening tools were used most often by healthcare organizations to identify individuals suffering from depression.


Click here to view the chart.

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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:
http://www.hin.com/library/registerhwi.html

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Reducing Time Spent Sitting Prevents Diseases, Risk of Death

A new study from American Cancer Society researchers shows that prolonged time spent sitting, independent of physical activity, has important metabolic consequences, and may influence health conditions like triglycerides, high density lipoprotein, cholesterol, fasting plasma glucose, resting blood pressure and leptin, which are biomarkers of obesity, cardiovascular and other chronic diseases. Time spent sitting can also affect your risk of death. According to the study authors, "Public health messages and guidelines should be refined to include reducing time spent sitting in addition to promoting physical activity. Because a sizeable fraction of the population spends much of their time sitting, it is beneficial to encourage sedentary individuals to stand up and walk around as well as to reach optimal levels of physical activity."

Increasing obesity levels in the United States are widely predicted to have major public health consequences. A growing epidemic of overweight and obesity has been attributed in part to reduced overall physical activity. And while several studies support a link between sitting time and obesity, type 2 diabetes, cardiovascular disease risk factors (11, 16, 17) and unhealthy dietary patterns in children and adults (18–20), very few studies have examined time spent sitting in relation to total mortality (21–23). Thus, public health guidelines focus largely on increasing physical activity with little or no reference to reducing time spent sitting.

To explore the association between sitting time and mortality, researchers analyzed survey responses from 123,216 individuals (53,440 men and 69,776 women) who had no history of cancer, heart attack, stroke or emphysema/other lung disease enrolled in the American Cancer Society’s Cancer Prevention II study in 1992. They examined the amount of time spent sitting and physical activity in relation to mortality between 1993 and 2006. They found that more leisure time spent sitting was associated with higher risk of mortality, particularly in women. Women who reported more than six hours per day of sitting were 37 percent more likely to die during the time period studied than those who sat fewer than three hours a day. Men who sat more than six hours a day were 18 percent more likely to die than those who sat fewer than three hours per day. The association remained virtually unchanged after adjusting for physical activity level. Associations were stronger for cardiovascular disease mortality than for cancer mortality. When combined with a lack of physical activity, the association was even stronger. Women and men who both sat more and were less physically were 94 percent and 48 percent more likely, respectively, to die compared with those who reported sitting the least and being most active.

To learn more about this research, please visit:
http://pressroom.cancer.org/index.php?s=43&item=257

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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. Join the 87 organizations that have already completed our survey on reducing avoidable ER visits and get a FREE executive summary of the compiled results.

To participate in this survey and receive its results, please visit:
http://www.surveymonkey.com/s/ervisits

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