The Latest Issue of the Population Health Management Journal

It's that time again! The Disease Management Care Blog spent 6 of its last 24 hours on the Pennsylvania Turnpike. That's nothing, however, compared to the many hours of hard work and ongoing commitments facing many DMCB readers. They can't just stop what they're doing and read those all those journals piling up on their desk corners. Good thing for them that the DMCB has a spouse and was able to ask her to take the wheel while it curled up with the latest issue of the Population Health Management Journal. After about a hundred miles, the DMCB emerged with this useful, efficient summary for your efficient perusing pleasure.

Michael Hopmeier, Jean Pape, David Paulison, Richard Carmona, Tim Davis, Kobi Peleg, Gili Shenhar, Coleen Conway-Welch, Sten Vermund, Janet Nicotera and Arthur Kellermann: Reflections on the Initial Multinational Response to the Earthquake in Haiti.

Put a bunch of disaster relief experts in a room and ask them how it went in Haiti in the days and weeks following the horrific quake and you'll learn about what went well and not so well. There could have been better anticipation of needs, better coordination, better use of bilingual expatriates, better security and a better transition plan toward sustainability. This is must reading for anyone interested in disaster preparedness, but has little use for workers in chronic illness, wellness and prevention. The DMCB wonders, however, if this article is ushering in the concept of a traditional part of public health laced with "population-based" approaches to disaster care?

Paul Terry, Jinnet Fowles, Lisa Harvey: Employee Engagement Factors that Affect Enrollment Compared with Retention in Two Coaching Programs - The ACTIVATE Study.

If you gave a wellness program and no one showed up, could you still call it a success? In this study, the authors describe the patent characteristics with their success. Stay Well Health Management offered two types of programs (“traditional health” and “activated health”) for two companies (one in health care and the other an airline) with a total target population of 1628 persons. In order to be counted as enrolled, persons had to complete a health risk assessment and go through clinical screening. 39% were enrolled, and of those enrolled, 64% were determined to be “high risk.” 61% of those enrolled stayed in the program for one year. Persons employed in health care, tobacco users and with statistically significantly higher levels of “health activation” were less likely to enroll, while those working in health care, older and white were less likely to stay enrolled. There is a flow chart that shows how over 1600 persons at the start percolated down to groups of 20 to 92 persons being retained in each arm of the study. The search for ways to boost enrollment continues. This is a good reference to show grumpy bosses and customers who insist you could have done better.

David Smith, Eric Johnson, Micah Thorp, Kathy Crispell, Xiuhai Yang, Amanda Petrik: Integrating Clinical Trial Findings into Practice Through Risk Stratification: The Case of Heart Failure Management.

After reading many publications on the topic, the Disease Management Care Blog suspects chronic heart failure is the condition most amenable to disease management. However, does that mean that all patients with heart failure should be targeted for disease management? This article tapped into that literature to develop a credible, soup-to-nuts review of what purchasers and payers could expect if they launched a disease management program in a community setting – like Kaiser’s in the northwest United States. In contrast to the 45% one-year admission rate reported in academic settings, Kaiser’s overall rate was lower at only 18%. Those at highest risk, based on a low ejection fraction (that they were able to use in their data thanks to the electronic record, had an admission rate of 33%. Assuming care management nurses cost around $25 per hour with 16 hours of nurse-time per patient, they determined the cost per patient was around $700. Based on the various cut-offs used in their predictive modeling with other reasonable assumptions on cost, utilization and effectiveness, the authors found that targeting disease management at the patients in the top 20% of risk of hospitalization had savings in excess of cost. Broadening care management to include persons at lower risk resulted in loss of a return on investment. The DMCB has run into this before and the logic has implications for insurance programs. It may be that access to special services should be based not only on the presence of a qualifying condition, but on the severity of the condition.

Jeff Beich, Dennis Scanlon ad Patti Boyce: A Community-Level Effort to Motivate Physician Participation in the National Committee for Quality Assurance Diabetes Physician Recognition Program.

This reports describes what happened when a several northern New York managed care plans (one of which was Medicaid) created a registry, used a tiered pay-for-participation program and supplied supportive consultation services to increase physician participation in the NCQA Diabetes Physician Recognition Program (DPRP). Of 79 physicians in 8 practices, 37 (47%) achieved recognition, with “considerable variation” among the DPRP measures. Physicians liked it when the Plans pooled their results. The docs were also genuinely interested in improving quality, relying on recognized metrics and, of course, the getting the additional payments. DPRP turned out to be more time consuming than anticipated and common reasons for not doing well in DPRP measures were getting the documentation done, getting the ophthalmologists to perform/code the all-important eye exam and having less control over the patient-dependent/controlled measures. Practice size and the presence of an electronic record did not appear to be associated with success, while greater physician autonomy was associated with less success. Problems with the registry included incorrect physician-patient attributions, delayed data entry and gaps in data by insurance type.

Albert Crawford, Christine Cote, Joseph Couto, Mehmet Daskiran, Candace Gunnarsson, Kara Haas, Sara Haas, Somesh Nigam, Rob Schuette and Joseph Yaskin: Comparison of the CE Centricity Electronic Medical Record Database and National Ambulatory Medical Care Survey Findings on the prevalence of Major Conditions in the United States

followed by another article with the same authors except JY

Prevalence of Obesity, Type II Diabetes Mellitus, Hyperlipidemia and Hypertension in the United States: Finding from the GE Centricity Electronic Medical Record Database

This issue of PHM was closed out with two back-to-back articles about a large commercial EMR. While the first article compared the population-based health status data of a large commercial electronic health record (in used by 20,000 providers taking care of 30 million persons) to the mother of all population-based measurement programs, the National Ambulatory Medical Care Survey (NAMCS), (younger persons of female gender with a higher burden of chronic illness seem to be accessing care than would be indicated by NAMCS), it raises a more important point: will the spread of electronic health records ultimately be the window that we utilize to assess our nation’s health status and use of health care services?

The companion article follows demonstrates the use of the electronic record data to describe the associations between BMI, age, gender, race, diabetes mellitus, hypertension and hyperlipidemia. None of the associations seemed particularly novel. Beware, though, says the DMCB: in order to extract these data, the researchers used methodologies that seemed quite specific to this particular electronic record. The DMCB looks forward to the day when health care providers can simply double click on a desktop icon and be able to access these kinds of summary statistics.