Newsbytes

Nurse intervention helps cardiac patients reduce cholesterol 

Patients who receive follow-up care from a nurse after bypass surgery are more likely to control cholesterol and reduce risk of further disease, according to a study from The Johns Hopkins University School of Nursing. The findings, published in the October issue of the American Heart Journal, “show that nurse case managers can greatly improve risk factor management in patients with coronary heart disease,” said lead author and professor Jerilyn Allen, ScD, RN.

In addition to standard care, including information and instructions for diet, activity, and monitoring pulse and temperature, 228 men and women were randomly assigned to 1 of 2 programs. One group received usual follow-up care enhanced with cholesterol-lowering medication and written reports on cholesterol levels sent to the patient and his or her primary care provider or cardiologist. In the other group, a nurse case manager offered individualized counseling, feedback on lifestyle modifications, and prescription and monitoring of cholesterol-lowering drugs. This latter program included an outpatient visit, follow-up phone calls, and communication about the patient's progress to his or her physician. The nurse case managers spent an average of less than 5 hours total per patient per year.

Although patients in both groups were prescribed the same medications, the nurse case managers in the second group monitored medication efficacy, adjusted the dosage as needed, and promoted compliance in taking the medication. Sixty-five percent of the patients in this group achieved recommended cholesterol levels, compared with 35% in the group receiving minimal intervention. Patients in the nurse-managed group also reported healthier diet and exercise patterns.

The study was funded by the National Institute of Nursing Research at the National Institutes of Health. For details, contact Ming Tai at (443) 287-2902 or mtai@jhmi.edu.

Research predicts trend of eroding health benefits 

WASHINGTON—The 2001 decline in the percentage of American workers receiving health insurance as an employment benefit is the start of a new trend, according to new research by the nonpartisan Employee Benefit Research Institute (EBRI). The November issue of EBRI Notes reported that coverage cutbacks were caused by the weak economy and rising health benefit costs, continuing trends that have hit small employers (with 25 or fewer workers) particularly hard, leading them to drop health benefits or require workers to pay more for them. This is the first fall in the percentage of Americans covered by employment-based health benefits since 1993.

Some of the article's key findings were as follows:

Blues association research points to technology explosion, hospital consolidation as causes of soaring care costs 

CHICAGO—The rapid proliferation of new medical technology and the growing trend of hospital consolidation, 2 largely actionable factors, are leading causes behind double-digit health care cost increases, according to new research released in October by the Blue Cross and Blue Shield Association (BCBSA).

As widely reported, 79% of health care costs are driven by hospital and physician costs. Although pharmaceuticals are still a major cost contributor, making up about 21% of the overall increase, inpatient hospital costs are outstripping pharmaceutical costs as a primary driver of expenses. BCBSA's research begins to answer why 19% of escalating hospital costs are directly related to the use and deployment of medical technology and 18% of the increase in hospital costs are driven by rising provider consolidation.

In addition to addressing technology and provider consolidation, the research also explores the impact of other factors, such as health care quality, the growing nursing shortage, and physician specialist costs. Expert researchers from the University of Southern California, the Lewin Group, and HealthShare Technology conducted the separate studies.

The full research reports and supporting documents are available at news.bcbs.com/proactive/newsroom/release.vtml?id=34284.

Perception of where HMO money goes differs from reality 

The perception of HMO members polled about where they think premium dollars go differs widely from how they actually are spent. The poll of 800 enrollees in several Blue Cross Blue Shield HMO plans in upstate New York was conducted by Zogby International on behalf of Excellus Inc, the plans' parent company.

Participants said they believe half the premium dollars are spent on medical care, 25% covers administration costs, and 25% is profit. Excellus, however, says 90% of premiums goes toward medical care, 7.5% is used for business expenses, and 2.5% is net income.

Scott Serota, president and CEO of Blue Cross Blue Shield Association in Chicago, said, “Until consumers gain a higher understanding and appreciation about how their health care dollars are being spent and their role as purchasers of health care, our ability to fully address the issues of access and affordability will be compromised.”

Business Insurance, Oct. 14, 2002

GlaxoSmithKline becomes first drug company certified in disease management 

PHILADELPHIA—GlaxoSmithKline (GSK) has become the first pharmaceutical company to earn Program Design Certification under the National Committee for Quality Assurance's (NCQA's) new disease management (DM) certification initiative. GSK's HealthCare Management Group submitted 3 of its programs—asthma, migraine, and smoking cessation—for certification. All 3 programs scored 100%.

With this certification, health plans have unbiased, third-party confirmation from NCQA that these DM programs are well designed, effective, and patient- and practitioner-friendly. In addition, health plans that use GSK's certified DM programs will receive automatic credit on related managed care accreditation requirements.

GSK's DM programs were reviewed primarily for their content and consistency with national practice guidelines. These programs have printed, electronic, and in-person materials and methods for working with patients and practitioners. Because of the importance of certification, GSK plans to seek certification for additional programs.

For details, contact Patty Seif at (215) 751-7709 or go to www.gsk.com.

Organizations collaborate on patient safety 

Utilization Review Accreditation Commission (URAC) and AdvancePCS are collaborating to identify approaches to improving patient safety through disease management (DM) programs. Funded by a grant from AdvancePCS, URAC will issue a call to the DM industry for innovative and effective practices that will be highlighted in case studies published on URAC's website and distributed to employers, purchasers, health plans, and other organizations.

URAC's Disease Management Advisory Committee will be invited to guide the project. URAC and AdvancePCS's Center for Healthier Aging will focus on practices in which health care organizations have the potential to identify and intervene in areas in which the risk of error is high. Many DM programs perform assessment and monitoring activities for chronically ill patients. Strategies may include the following:

For more information, contact Liza Greenberg at (202) 962-8805 or lgreenberg@urac.org.

Increasing bone density testing for osteoporosis 10% may save Medicare $15 million 

Data presented in a plenary session at the annual scientific meeting of the American College of Rheumatology last fall estimated that a modest 10% increase in bone mineral density (BMD) testing to detect osteoporosis could save Medicare $15.5 million over 3 years. Projected medical cost savings of $32.3 million would offset the extra cost of testing.

An estimated 12% of women 65 and older with osteoporosis or osteopenia (low bone mass) received a Medicare-reimbursed BMD test to detect the disease in 2001. The study projects that testing 180,000 additional women—just 10% of the population—with osteoporosis or osteopenia would reduce the incidence of osteoporotic fractures at the hip, spine, and wrist by more than 6500 over 3 years, yielding the Medicare savings.

Kenneth Saag, MD, an author of this study, said, “Medicare savings from avoided fractures could be used to subsidize patient costs, education, and other interventions that have been shown to increase overall osteoporosis diagnosis and treatment rates. This would ultimately prevent more fractures and provide patient benefit while further reducing Medicare costs.”

The study was sponsored by the Alliance for Better Bone Health, a group formed by Procter & Gamble and Aventis in May 1997 to promote bone health and disease awareness. For more information, visit www.pg.com or www.aventis-us.com.

Vitamin E may prevent early artery damage 

WASHINGTON—New research at 2 leading institutions, Johns Hopkins in Baltimore and the University of California at Berkeley, has found that vitamin E helps prevent oxidation leading to early artery damage and that women may need higher amounts of antioxidant vitamins than men to counter oxidation.

At Johns Hopkins, researchers conducting a clinical trial found that vitamins E and C, both known as effective antioxidants, appear to prevent early artery damage when taken separately, not together. The 2-month trial involved 184 nonsmoking adults who were middle-aged or older. Four daily regimens were tested: 400 IU of vitamin E alone, 500 mg a day of vitamin C alone, both vitamins taken together, and a placebo pill. Both vitamins reduced oxidation of blood fats, which can play a key role in early formation of plaque that clogs arteries.

Results of the trial have been published in the American Journal of Clinical Nutrition. The researchers noted that food intake alone does not provide the necessary level of vitamin E, a finding of many previous studies that recommend additional vitamin E in supplement form.

At the University of California at Berkeley, preliminary research found that women may experience more oxidation than men, leading to suggestions that women need higher amounts of antioxidant vitamins, such as vitamin E, to fight off damaging oxidation.

Birth weight and diabetes in pregnancy 

Women who were classified as low birth weight (LBW) when they were born are more likely to develop pregnancy-related diabetes, say investigators publishing in the October issue of Diabetes Care. The link is especially strong for LBW women who have larger babies.

A scientific hypothesis called the “thrifty phenotype” holds that LBW is related to insulin resistance in the development of Type 2 diabetes in adults, mainly as a result of a delay in organ maturation triggered by smaller neonatal size. Pregnancy is known to create insulin resistance, and many women develop a condition known as gestational diabetes mellitus (GDM) that generally clears up after the baby is born. These researchers studied the relationship between LBW and diabetes in pregnancy.

They enrolled 604 pregnant women in their study, 142 of whom had GDM. They classified the women into groups according to maternal birth weight. Results showed women in the lowest birth weight group were about twice as likely to have GDM than those in the higher birth weight groups.

In the second part of the study, researchers assessed the relationship between birth weight of the offspring and the rate of GDM in 450 of the women. This analysis indicated a two-fold greater incidence of GDM in LBW women who had larger infants. The authors believe a woman's own birth weight could play a significant role in helping doctors determine which women are especially high-risk for developing diabetes during pregnancy.