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September 23, 2010 Volume VII, No. 12

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

In this week's issue, we focus on asthma medication and management. Find out if asthma medication can benefit MS patients as well as if pediatricians are using recommended methods of diagnosing and managing asthma in children.

And have childhood immunization rates increased or decreased? Get the answer in this issue.

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

This week's DM news:

Table of Contents

  1. Asthma Meds & MS
  2. Asthma Treatment & Pediatricians
  3. Medication Therapy Management
  4. DM Case Loads
  5. Case Manager Monthly Caseloads
  6. Patient Education Benchmarks
  7. Childhood Immunization Rates
  8. Telehealth in 2010

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Melanie Matthews, mmatthews@hin.com

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Asthma Medication May Benefit Patients With MS

Adding albuterol, a compound commonly used to treat asthma and other respiratory diseases, to an existing treatment for patients with multiple sclerosis (MS) appears to improve clinical outcomes, according to a report in the September issue of Archives of Neurology.

MS is a chronic inflammatory disease characterized by the degeneration of myelin, which coats nerve cells in the white matter of the central nervous system. Patients with the condition have been found to have elevated levels of interleukin-12, a biological compound that promotes the generation of a type of helper T cell that may be associated with myelin destruction. Albuterol sulfate — commonly used to treat bronchospasm, a constriction of the airways within the lungs as often occurs in asthma — may decrease interleukin-12 levels, the researchers note. Researchers assessed the effects of albuterol treatment as an add-on therapy for patients starting treatment with glatiramer acetate, currently approved as a therapy for relapsing-remitting MS.

A total of 44 patients were randomly assigned to receive daily subcutaneous 20-milligram injections of glatiramer acetate plus either an oral dose of 4 milligrams of albuterol or placebo daily for two years. Participants were examined by a neurologist at the beginning of the study and at six, 12, 18 and 24 months, and blood samples were collected at the beginning and at three, six and 12 months into the study. Magnetic resonance imaging (MRI) of the brain was performed at enrollment, 12 months and 24 months. A total of 39 patients participated long enough to contribute to the analysis.

In assessments of functional status, improvement was observed in the glatiramer acetate plus albuterol group compared with the placebo group at six months and 12 months but not at 24 months. Compared to patients taking placebo, those taking albuterol also experienced a delay in the time to their first relapse. Blood tests showed that the production of two inflammatory markers — interleukin-13 and interferon-gamma — decreased in both treatment groups, with a treatment effect on interleukin-13 observed at the 12-month time point. Adverse events were generally mild, with only three moderate or severe events that were considered to be related to the treatment (including reaction at the glatiramer acetate injection site, leg weakness and chest tightness). The researchers conclude that, "treatment with glatiramer acetate plus albuterol is well tolerated and improves clinical outcomes in patients with MS. The combined regimen seems to enhance clinical response during the first year of therapy.”

To learn more about this research, please visit:

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Method to Diagnose, Manage Asthma Underused by Pediatric PCPs

The recommended method to diagnose and manage asthma in children is underused by pediatric primary care physicians (PCPs), University of Michigan researchers have found. Only 21 percent of doctors surveyed reported the routine use of the guideline-recommended method for assessing lung function known as spirometry. Further, only half of the PCPs correctly interpreted spirometry results in a standardized clinical vignette.

According to the researchers, "Previous studies suggest that doctors often underestimate asthma severity in the absence of spirometry results. The course of treatment may be altered substantially when spirometry information is made available. The National Asthma Education and Prevention Program Expert Panel Report guidelines underscore the importance of spirometry in the initial diagnosis of asthma and at least once per year thereafter for ongoing management."

Researchers surveyed 360 general pediatricians and family physicians who provide care to children with asthma. They found that 52 percent of physicians used spirometry, while 80 percent reported using peak flow meters, which are not recommended due to their variable test results. Only 21 percent indicated that they routinely used spirometry to establish an asthma diagnosis, classify severity and assess patients’ level of asthma control — the three clinical situations outlined in the national asthma guidelines. Use of spirometry was more common among family physicians than among pediatricians. The study also found that only half of the surveyed physicians correctly interpreted the spirometry results from the clinical vignette, while 14 percent indicated that they did not know how to interpret the results.

More physicians underrated the severity of an asthma case after interpreting spirometry results in conjunction with asthma symptoms. “This suggests that gaps exist in the application of spirometry results,” said the researchers. “Underrating asthma severity could lead to undertreatment of asthma, which has been linked to increased risk of serious asthma flare-ups.” The researchers also added that, “It is clear from this study that PCPs lack comfort and ability interpreting spirometry results. Additional training will be important for many pediatric PCPs and their staff members to promote widespread use of spirometry and to ensure correct interpretation of results.” Researchers say that future studies should be done to determine the effectiveness of different types of spirometry training in pediatric primary care settings.

To learn more about this research, please visit:

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Medication Therapy Management in the Patient-Centered Medical Home

The pharmacist has a natural and important role in patient medication reconciliation and review, explains Dr. Beth Chester, senior director of clinical pharmacy services and quality, Kaiser Permanente Colorado. She describes the dramatic impact that a pilot pharmacist intervention had on emergency department visits and mortality rates among patients just discharged from skilled nursing facilities (SNFs) once the health plan's pharmacists stepped in to monitor medication therapy in this population.

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DM Case Loads in Medical Homes

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Marcus Barnes, director of the Richland Care Medical Home Network, Palmetto Health.

Question: How did you deploy DM? In deploying DM, do you use case managers or extenders? How many cases are there per full-time employee?

Response: We have a nurse case manager. She is a registered nurse (RN) and has one other employee who is a licensed practical nurse (LPN) who serves as a community health coordinator. Their case loads fluctuate, but they can have anywhere from 20 to 30 participants. Some are visited weekly, some are visited every two or three weeks — it depends on the situation. They follow these patients even when they’re not visiting them. We also have a step-down program. Once the participant reaches a certain level where they’re maintaining their hypertension or diabetes at a fairly safe level, then we transition them out to a less intensive program. That is where we have employees that call them on a monthly basis just to check in, see how they’re doing, see if they need anything and to see if there’s a need for them to reenter our intense DM program.

For more information on DM case loads and the medical home, please visit:

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Case Manager Monthly Caseloads

Healthcare case managers are playing a larger role in the coordination of all phases of patient care — from management of the chronically ill in primary care to monitoring hospitalized patients from pre-admission through post-discharge to overseeing care of residents in long-term care facilities. We wanted to identify the average monthly case load of a case manager.

Click here to view the chart.

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Benchmarks in Patient Education — Prevention, Self-Care Top Lessons

How prevalent are patient and member education programs, and which health areas are addressed by these efforts? How are healthcare organizations delivering health education, and who is the primary health educator? What is the chief impact of patient education programs, and how do organizations measure ROI from patient education efforts? The Healthcare Intelligence Network set out to answer these questions and others during its 2009 Patient Education and Outreach Benchmarks e-survey. This executive summary of responses from 134 healthcare organizations offers lessons in the value of educating patients and members about disease management and self-care.

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Childhood Immunization Rates Remain High

Immunization of children aged 19-35 months old against most vaccine-preventable diseases remains high in the United States, with coverage for most of the routine vaccines remaining at or over 90 percent, according to a report by the CDC. And less than 1 percent of young children received no vaccinations, the CDC report said.

The 2009 National Immunization Survey (NIS) of more than 17,000 households looked at vaccination of children born between January 2006 and July 2008 and found that vaccine coverage against poliovirus; measles, mumps and rubella; hepatitis B and varicella (chickenpox), remained relatively stable and near or above the national Healthy People 2010 goal of 90 percent or higher. At the same time, rates of vaccination for hepatitis A and the birth dose of hepatitis B increased significantly, with the number of children aged 19-35 months who were immunized rising by more than six and five percentage points respectively.

Other findings included:

  • 44 percent of children aged 19-35 months had received rotavirus vaccine during infancy; these vaccines were first licensed in 2006.
  • 83.6 percent of children aged 19-35 months had received three doses of Haemophilus influenzae B, down by 6.4 points from the previous year, reflecting a national shortage of the vaccine in 2008 and 2009. Vaccine is now readily available.
While the national picture is reassuring, in 2008, there were outbreaks of measles primarily in children whose parents had declined to have their children vaccinated. It is likely that communities with high numbers of undervaccinated or unvaccinated children remain, said the researchers. "While it's encouraging to see immunization rates remaining high, we know that parents have questions about vaccines and we must continue to educate parents about the importance of vaccination to help avoid future resurgences in serious, preventable illnesses," according to the researchers. The researchers also noted that there was substantial variation between states in vaccination rates, suggesting room for improvements.

To learn more about this research, please visit:

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Telehealth in 2010

Join the more than 70 organizations that have taken HIN's second annual e-survey on Telehealth and Telemedicine to find out how organizations are using and benefiting from telehealth and telemedicine. Complete the survey 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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