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September 2, 2010 Volume VII, No. 9

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

Like the rest of the country, California is seeing an increase in obesity and diabetes rates, which is also increasing medical costs for the state. This issue takes a closer look at these California rates, as well as the seasons' effect on MS activity, and a new therapy for patients at “intermediate risk” of heart disease.

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

This week's DM news:

Table of Contents

  1. MS & Seasons
  2. Obesity, Diabetes Calif. Rates
  3. Patient Activation Measure & DM
  4. Health Coaching Versus Counseling
  5. Critical Care Transitions
  6. Reducing Avoidable ER Visits
  7. Benefiting from Statin Therapy
  8. Telehealth in 2010

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Melanie Matthews, mmatthews@hin.com

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Multiple Sclerosis Activity Changes with the Seasons

New research published in an issue of Neurology®, the medical journal of the American Academy of Neurology, shows that multiple sclerosis (MS) activity can increase during spring and summer months. According to study author Dominik Meier, Ph.D., of Brigham and Women’s Hospital in Boston and a member of the American Academy of Neurology, “Our results showed that the appearance of lesions on brain scans was two to three times higher from March to August, compared to other months of the year.”

For the study, researchers compared MRI brain scans of 44 people taken from 1991 to 1993 to weather data from the same time period. Participants were between the ages of 25 and 52 with untreated MS. Each person had eight weekly scans, then eight scans every other week followed by six monthly check-ups, for an average of 22 scans per person. Weather information included daily temperature, solar radiation and precipitation measurements for the Boston area. After one year, 310 new lesions were found in 31 people. Thirteen people had no new lesions during the study. “Not only were more lesions found during the spring and summer seasons, our study also found that warmer temperatures and solar radiation were linked to disease activity,” said Meier. There was no link found between precipitation and lesions.

One significant aspect of the research is that clinical trials often use MRI to assess the effectiveness of a drug and studies commonly last between 6 and 12 months. If the study ran from spring to winter, it may appear that lesions decreased due to drug effect but the cause might just be the change of seasons. The opposite would occur if a study started in winter and lasted through the spring and summer.

To learn more about this research, please visit:

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Obesity, Diabetes Epidemics Grow in California, Diabetes Jumps 26 Percent

A majority of adults in California are obese or overweight, and more than 2 million have been diagnosed with diabetes, according to a new study from the UCLA Center for Health Policy Research. Both conditions — which are related to each other as well as to heart disease — increased significantly in just six years, with the prevalence of diabetes alone jumping nearly 26 percent between 2001 and 2007. The "epidemic" of obesity and diabetes leaves no racial, ethnic, economic or geographic segment of the state unscathed, according to the researchers. Although American Indians, African Americans and Latinos are particularly affected by both obesity and diabetes, these conditions increased among all racial and ethnic groups between 2001 and 2007. Similarly, while both conditions disproportionately affect the poorest Californians, there were upward trends in prevalence among all income groups during the same time period. California's youth are also affected: More than a quarter of California adolescents — some 970,000 children — are obese or overweight.

In California, the total annual cost of diabetes is estimated to be $24 billion, with $17 billion spent on direct medical care and $7 billion on indirect costs associated with the disease. The cost of obesity to families, employers, the healthcare industry and the government is equally steep: $21 billion. If obesity and diabetes continue to affect more and more of the population, the associated costs will continue to grow.

The study found that obesity prevalence was highest in Imperial (39.6 percent), Merced (34.3 percent) and Tulare (31.1 percent) counties in California, while diabetes prevalence was highest in Tulare (12.1 percent) and Fresno (10.9 percent). Regionally, the San Joaquin Valley had the highest prevalence of both obesity (30.0 percent) and diabetes (9.4 percent). Los Angeles County, due to the size of its population, had by far the most obese residents (1.7 million) and the most residents diagnosed with diabetes (642,000). Adults living below the poverty line had a significantly higher prevalence of obesity (27.7 percent) than higher-income adults (19.6 percent). Similarly, diabetes was more prevalent among the poorest adults — those living below 200 percent of the federal poverty level. And it was also found that the prevalence of obesity was nearly twice as high among adults with no more than an eighth-grade education (30.3 percent) as among those who graduated from college (14.9 percent). Diabetes prevalence was three times as high among adults with no high school education (14.8 percent) as among those who graduated from college (5.1 percent).

The study specifically recommends that policymakers and others seek ways to increase access to recreational facilities and parks, as well as promote policies that encourage farmers markets and improve access to food outlets that stock fresh fruits and vegetables and other healthy fare. The consequences of failure are severe — California is falling far short of the targets for obesity and diabetes set by Healthy People 2010, a national health promotion and disease prevention plan. For example, obesity among California adolescents is more than twice as high as the national target of 5.0 percent, while the rate of diabetes among California adults is more than three times the federal goal of 2.5 percent of the population.

Although there are a number of factors associated with diabetes and obesity, ranging from genetics to individual behaviors, the composition and structure of neighborhoods and social environments have been increasingly implicated as impediments to maintaining a healthy lifestyle. Both physical activity and healthy eating are important for preventing and reducing obesity and diabetes. California has enacted reforms to encourage healthy eating, including requiring chain restaurants to display calorie information and prohibiting the sale of soda and other sweetened beverages on K–12 school campuses.

To learn more about this research, please visit:

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Use of the Patient Activation Measure in DM

American Health Holding relies on the Patient Activation Measure™ to assess a patient’s level of engagement in their own overall DM, but it does more than just that. PAM scores are also used to gauge the success of the DM program and its coaches. Director of DM and wellness services Diane Bellard discusses PAM — who is using it, how to deal with a decrease in PAM levels, how it fits with a patient's readiness to change and PAM's role in an organization's overall quality improvement.

To listen to this complimentary HIN podcast, please visit:

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Drawing the Line Between Coaching and Counseling

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

Question: How do your programs help health coaches draw the line between coaching and counseling?

Response: (Darcy Hurlbert) We added a depression risk screening. We screen for symptoms of depression and make sure we refer to EAP for individuals who show symptoms or signs of being depressed. Our coaches are trained to identify when individuals are crossing the line. Part of health coach training is learning where to draw the boundary and when to refer to the right resources. It is a matter of training coaches, providing them with this depression screening tool and then making sure they have information on where to refer the individual if they feel that individual needs counseling assistance.

(Sean Slovenski) With every coaching program, we have strong protocols. One aspect of the protocols is the red flag section, which will vary by topic area and depression. We are pre-screening people when they enroll to make sure they are right for a coaching program. We monitor if things are coming up that hit these red flag marks. For example, if a parent starts talking about being angry all the time, there are key words you look for about child abuse. We know it is something that goes beyond coaching, and there is greater need for help. Another example is, “I did my run yesterday, coach, and everything was fine, but I got this clicking sound in my knee, and it hurts.” That is a medical issue — we are not going to say, “Let’s try and figure out what that is — twist it like this, twist it like that, and does it hurt? Why don’t you try some ice for three days?” That goes beyond subclinical into clinical. For each area, from medical-related to issues such as exercise, managing weight or dealing with relationships, we have red flags.

For more information on health coach hiring and training, please visit:

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The 7 Most Critical Care Transitions

Tighter management of transitions in care can help to close care gaps, avoid unnecessary hospitalizations, readmissions and ER visits, reduce medication errors and raise the bar on care quality. We wanted to see which care transitions are being addressed by healthcare organizations.

Click here to view the chart.

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2010 Benchmarks in Reducing Avoidable ER Visits

As consumers and payors take on greater responsibility for the efficiency of the healthcare system, healthcare organizations are targeting avoidable emergency room use. This white paper captures the steps that 90 healthcare organizations are taking to reduce avoidable use of the hospital ER, including the three most effective programs to prevent inappropriate use. These benchmarks are based on organizations' responses to the Healthcare Intelligence Network July 2010 e-survey on reducing avoidable ER use.

To download this complimentary white paper, please visit:

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People at “Intermediate Risk” of Heart Disease Benefit from Statin Therapy

Women and men with a 10-year cardiovascular disease (CVD) risk of 5 percent or more and normal cholesterol levels but high levels of high sensitivity C-reactive protein (hsCRP), a protein associated with inflammation, could reduce their risk substantially with statin therapy, according to new research published in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal. This study is a new analysis of data from the randomized, placebo-controlled, double blind Justification for Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER). The study included men 50 years or older and women 60 years or older. Statins are known to reduce levels of both cholesterol and hsCRP, and statin therapy is not a substitute for a healthy diet, smoking cessation and exercise.

For patients with elevated hsCRP, the study found that taking cholesterol-lowering statin drugs could reduce the relative risk of CVD:

  • By 45 percent for people estimated to have a 10-year CVD risk of 5 to 10 percent.
  • By 49 percent among those with an estimated 11 to 20 percent 10-year risk.
“These data demonstrate that women and men with elevated hsCRP who are otherwise at 5 to 20 percent 10-year risk had substantive risk reductions with statin therapy even though they are currently outside United States treatment guidelines,” said Paul Ridker, M.D., lead study author and director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital. People with a 10-year risk of less than 5 percent did not have a statistically significant reduction in events with statins.

The current study finds that although men and women in the 5 to 10 percent Framingham 10-year risk group get equal benefit from statin therapy, more women tend to be in the 5 to 10 percent risk group while men tend to be in the 11 to 20 percent group. “The current U.S. recommendations label individuals with a greater than 20 percent 10-year Framingham risk as high risk and advise statin therapy for them. Statin treatment for individuals with Framingham risk under 20 percent has until now been less clear-cut,” said Dr. Ridker. These data also support the current position taken by the American Heart Association and the CDC that hsCRP testing is best used in people with intermediate risk to help doctors in their treatment decisions.

To learn more about this research, please visit:

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Telehealth in 2010

Powered by provisions in the Patient Protection and Affordability Act, healthcare delivery via telehealth and telemedicine is transforming wellness, disease management, medication management services and illness prevention while extending access to critical healthcare services. Complete HIN's second annual e-survey on Telehealth and Telemedicine by September 30 and 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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