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September 30, 2010 Volume VII, No. 13

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

HHS has awarded $100 million for public health and prevention priorities, including HIV prevention, weight management and tobacco cessation. Learn more about these prevention grants in this week's issue. And speaking of weight management, could a roommate's weight affect the weight of a college woman? And can physical limitations such as overweight affect the mortality of breast cancer survivors? Read on for the answers to these questions.

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

This week's DM news:

Table of Contents

  1. Weight & College Women
  2. Breast Cancer Patients & Physical Limits
  3. Primary, Behavioral Care in Medical Home
  4. Best Incentives for Wellness
  5. Tactics to Reduce Avoidable ER Use
  6. Healthcare Case Management
  7. Public Health & Prevention Priorities
  8. Telehealth in 2010

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Melanie Matthews, mmatthews@hin.com

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Busting the Freshman 15 Myth: College Women with Heavy Roommates Gain Less

College women with roommates who weigh more than average gain less weight during their freshman year than women with slimmer roommates: half a pound versus 2.5 pounds, according to a University of Michigan study. That compares to the typical freshman weight gain of 2.5-to-6 pounds — much less than the mythical "Freshman 15." According to researchers, heavier roommates are more likely than average-weight women to diet. They also exercise more often and are more likely to use weight loss supplements and purchase college meal plans that limit access to food. "It's not really the weight of your roommate that's important, but the behaviors your roommate engages in," said the researchers. "These behaviors are what may really be 'contagious.'"

The study is the first to assess college weight gain using a natural experiment occurring on most college campuses in the United States — randomized roommate assignments. For the study, the researchers assessed 144 female college students randomly assigned to share a living situation during their freshman year. At the start of the fall semester, the researchers obtained the women's weight and height, and asked about weight management behaviors. These included whether they had tried to lose weight at any time during the previous year, the average number of times per week they went to the gym and exercised outside, and whether they had signed up for an unlimited college meal plan. The topic of peer influences on weight gain and weight management is important since obesity prevalence in young adults, aged 18 to 29, increased by 96 percent from 1988 to 2006 — the largest percentage increase for all age groups.

Another study found that freshmen assigned to dormitories with onsite dining halls gained more weight than those who had to venture outside of their dorms for food. In the future, the researchers will expand their study of the issue by analyzing a larger sample of students at a public university to see if roommate weight patterns persist. They will also examine other environmental influences and see if the findings vary with race, ethnicity or socioeconomic status.

To learn more about this research, please visit:
http://www.ns.umich.edu/htdocs/releases/...

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Physical Limitations Take Significant Toll in Breast Cancer Survivors

Basic physical limitations following breast cancer treatment can have far-reaching consequences that substantially affect how long a patient lives. According to a new study, breast cancer survivors with functional limitations — an inability to perform normal daily activities — caused by the disease or its treatment are more likely to die because of overall poorer health. The scientists found that survivors who reported physical limitations after breast cancer treatment have the same risk of dying from breast cancer as those without limitations but are more likely to die from other diseases. In particular, investigators found that older women, as well as overweight breast cancer patients, were more likely to experience functional impairments for at least 18 months after treatment. The research points to risk factors where, with simple modifications in habits that allow more physical activity, health might be greatly improved. The impairments, affecting motion, strength and dexterity, include an inability to kneel, to lift items heavier than 10 pounds or to handle small objects, to stand in place, to sit for long periods, to walk up and down a flight a stairs, to walk two or three city blocks.

To determine how physical limitations following initial breast cancer treatment affect mortality, the scientists studied 2,202 women in California and Utah with breast cancer, questioning them about endurance, strength, muscular range of motion and small muscle dexterity following initial treatment such as chemotherapy, radiation therapy or hormone therapy. The women were part of the Life After Cancer Epidemiology cohort and were followed for up to 11 years after diagnosis.

Outcomes differed according to disease stage. Women with localized cancer had higher rates of non-breast cancer death due to functional limitations than those with more advanced disease. In addition, women with functional limitations may have poorer treatment tolerance because they are more likely to be older, less physically active and overweight or obese. As a result, the authors speculate that women with good physical function who tolerated therapy well might be over-represented in the group with more advanced disease.

“There is increasing evidence that regular physical activity, as little as 30 minutes of moderate intensity walking each day, can reduce the risk of breast cancer recurrence,’’ said researchers. “Women with functional limitations are less likely to be able to maintain regular physical activity and would likely benefit from intervention to reduce their limitations and increase physical activity.’’ Though the researchers did not specifically study the mechanism, they suggest that functional limitations may be associated with chronic inflammation, a key aspect of the immune system’s defenses, which can lead to diminished function of organs or systems.

With better detection and treatment, more breast cancer patients are surviving longer. According to the National Cancer Institute, an estimated 2.5 million women with a history of breast cancer were alive in 2006 — most of them cancer-free. The overall five-year survival rate for localized breast cancer is 98 percent, reports the American Cancer Society, while the survival rate for breast cancer that has spread to the chest wall or lymph nodes is in the 80 percent range; at least 25 percent of breast cancer patients whose disease has metastasized survive five or more years. Despite improved survival rates, many patients struggle with physical limitations after treatment — as many as 39 percent, according to the new findings — yet little attention has been paid to those limitations and related problems, particularly among older women.

To learn more about this research, please visit:
http://news.ucsf.edu/releases/physical-limitations...

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Integrating Primary Care and Behavioral Healthcare in the Medical Home

Individuals with severe and persistent mental illnesses are likely to die 20 years earlier than people without such conditions, says Liz Reardon, president of Reardon Consulting and a member of the National Council for Community Behavioral Healthcare (NCCBH) Integration Consulting Team. Putting the right medical home services in place for adults with chronic mental illness can help to reduce this disparity, suggests Reardon.

To listen to this complimentary HIN podcast, please visit:
http://www.hin.com/podcasts/podcast.htm#89

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Most Effective Incentives for Wellness

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Dr. Jim Reynolds, chief medical officer for Health Fitness Corporation.

Question: What are some of the most effective incentives to use to gain patient engagement in wellness?

Response: It is important to align incentives, which means that the incentive must be meaningful and of value to the individual. Gift cards, trinkets, those types of things are typically not impactful. Cash can be very effective, in the form of American Express Cards or just plain cash. Linking incentives to benefits is also very effective. Benefit-linked incentives are things such as premium reductions for participation and removal of some co-pays — for example, the removal of co-pays for medications for chronic conditions like high blood pressure, diabetes and asthma — and contributions to a health savings account (HSA). Contests and drawings where not every individual will get an incentive but has an opportunity at one had variable effectiveness depending on the demographics of the population. If the company has a very strong culture of health, a strong communication campaign and high involvement and engagement of senior management, it can typically get by with lower incentives to get higher participation.

For more information on wellness and incentives, please visit:
http://store.hin.com/product.asp?itemid=4046

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

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Top Tactics to Curb Avoidable ER Use

As consumers and payors take on greater responsibility for the efficiency of the healthcare system, healthcare organizations are targeting avoidable emergency room use. We wanted to see the top tactics in use to prevent inappropriate use of the ER.

Click here to view the chart.

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Benchmarks in Healthcare Case Management

Healthcare case managers are playing a larger role in the coordination of all phases of patient cares. This HIN white paper examines the expanding focus, responsibilities and impact of case management in healthcare, from populations benefiting from case management to metrics on case loads, ROI and performance measurement through responses provided by 187 healthcare organizations.

To download this complimentary white paper, please visit:
http://www.hin.com/library/registerhcm.html

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HHS Awards $100 Million for Public Health and Prevention

Six months after the Affordable Care Act was signed into law, HHS has announced nearly $100 million in grants made possible primarily by the new law’s Prevention and Public Health Fund. The grants will support a variety of critical public health programs in states and local communities — from tobacco quit lines to HIV testing to programs that help address and tackle substance abuse and mental health issues. The grants represent proven programs run by divisions and centers across HHS. Nearly $68 million of the grants will fund key state and local public health programs supported through the CDC. Another $26.2 million will go to state and community substance abuse and mental health programs from SAMHSA. One grant from the Health Resources Services Administration (HRSA) will go toward launching the Healthy Weight Collaborative at the Prevention Center for Healthy Weight.

The CDC announced awards of approximately $21.6 million to expand HIV prevention efforts under the President’s National HIV/AIDS Strategy (NHAS). The funding will help to further focus HIV prevention on high-risk populations and communities, as well as fill critical gaps in data, knowledge and understanding of the epidemic. The majority of the grants ($11.6 million) will support demonstration projects to identify and implement a “combination approach” to enhance effective HIV prevention programming in 12 hard-hit areas across the country. These efforts will determine what mix of HIV prevention approaches can have the greatest impact in the local area, supplementing existing programs in these communities and helping jurisdictions to better focus efforts on key at-risk populations and fulfill unmet needs.

Six communities — all part of the original 44 Communities Putting Prevention to Work (CPPW) communities — will divide $9.3 million in support of obesity efforts to examine change in community-level variables (such as change in use of cafeteria foods), and BMI and related biometric measures. Also, HRSA has awarded $5 million from the Prevention and Public Health Fund to the National Initiative for Children’s Healthcare Quality (NICHQ) in Boston to create and manage a new Prevention Center for Healthy Weight to address obesity in children and families. The center will launch the Healthy Weight Collaborative to share evidence-based and promising community-based and clinical interventions in preventing and treating obesity.

State supplemental funding for healthy communities totaling $3.8 million is being divided among 46 locations. The funds will be used to help states implement plans to reduce tobacco use through regulatory and educational arenas, as well as enhance and expand the national network of tobacco cessation quit lines to significantly increase the number of tobacco users who quit. Also, SAMHSA awarded more than $26.2 million in grants to support and promote better primary care and behavioral health services for individuals with mental illnesses or substance use disorders. The grants seek to improve health by improving the coordination of healthcare services delivered in publicly funded community mental health and other community-based behavioral health settings.

To learn more about this research, please visit:
http://www.hhs.gov/news/press/2010pres/...

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Telehealth in 2010

Today's the last day to join the more than 100 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:
http://www.surveymonkey.com/s/telehealth2010

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