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An e-bulletin created for health care systems working with patients to control their diabetes and high blood pressure.
September 2017
WHY? Education and Support for Patients with Chronic Disease Triple Aim alignment. Chronic Disease Self-Management Programs such as Better Choices, Better Health support your efforts to meets the Institute for Healthcare Improvement’s Triple Aim design requirements for new models of care: (1) improving the patient experience of care (including quality and satisfaction); (2) improving the health of populations; and (3) reducing the per capita cost of health care. Achievement of quality performance goals depends on patient self-management. Performance-based contracts include quality measures associated with patient self-management (e.g., A1C, cholesterol). Better Choices, Better Health improves treatment plan adherence and, in turn, key quality measures being used by CMS/Medicare.
IOWA DOES WELLOn 8-7-2017 Gov. Kim Reynolds’ office (8-7-2017) announced a new ranking that scored Iowa high for health care. According to the personal finance website, wallethub.com, Iowa ranked second best for health care in 2017 among the 50 U.S. states and the District of Columbia. The governor’s office issued a news release noting that WalletHub used 35 measures of cost, accessibility and outcomes to determine where Americans receive the highest-quality services at the best prices. Iowa scored first for most hospital beds per capita and second for the lowest infant mortality rate. Iowa also was sixth nationally for the percentage of insured adults and 10th for the percent of insured children.
First “Artificial Pancreas” Systems Are Coming To MarketUSA Today (5/2, Feibus) reports that the first artificial pancreas systems “are now beginning to come to market.” The systems are “wearable devices that take charge of the crucial process of measuring glucose levels and delivering precise doses of insulin.” Medtronic “became the first supplier out of the gate when it began outfitting a pre-selected pool of type 1 diabetes patients with its new MiniMed 670G.” Other companies, “including startup Bigfoot Biomedical, Insulet and a partnership between Dexcom, Tandem and TypeZero,”are hot on Medtronic’s heels, with active studies now underway and plans to go to market late this year or in 2018.
A1C improvements tied to insulin initiation in primary care, study findsAustralian researchers found that type 2 diabetes patients who received the "Stepping Up" model of care, which enhanced the practice nurses' role in leading insulin initiation and offered mentoring by a registered nurse with diabetes educator credentials, had an absolute 0.5 percent reduction in A1C from baseline to 12 months, compared to the control group. The findings in The BMJ revealed that 36 percent of those in the intervention group and 19 percent of control participants achieved target A1C levels. ClinicalAdvisor.com (3/20)
The Star Tribune: Minnesota Pays Huge Price For Diabetes, Blue Cross Study FindsOne in 16 privately insured Minnesotans suffer a “loss of good health” due to diabetes, according to a new analysis by Blue Cross and Blue Shield of Minnesota, which adds up to thousands of people who will never reach their full life expectancies or will suffer chronic disabilities. The analysis, released Tuesday, is based on a new national Blue Cross “health index” tool that estimates the prevalence and cost of diseases in states and counties based on the private insurance claims of 40 million Americans. (Olson, 8/8)
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PCOR evidence on Aspirin and Heart DiseasePatient-Centered Outcomes Research (PCOR) evidence shows taking aspirin can help patients lower their risk of heart disease. EvidenceNOW references the scientific evidence and clinical guidelines from the 2011 American Heart Association (AHA) and the American College of Cardiology Foundation (ACCF). Learn more about the PCOR evidence behind aspirin use for high-risk individuals.
Study: Combined low-dose BP meds may effectively control hypertensionA study in the journal Hypertension found a combination of quarter doses of four blood pressure-lowering drugs had almost twice the effectiveness of a full dose of one drug, while a combination of quarter doses of two drugs demonstrated similar effectiveness to a full dose of one drug. The findings, based on data from 42 studies that involved 20,284 participants with hypertension, also found fewer side effects with quarter-dose therapies. HealthDay News (6/5)
Stroke rates declining for men but not for womenABC World News Tonight (8/9, story 12, 0:20, Muir) reported a new study found that “fewer men are suffering strokes in the US while the number of women having strokes remains the same.” The CBS Evening News (8/9, story 9, 2:10, Mason) calls the findings “a puzzling and concerning trend.” Kathryn Rexrode, MD, from Brigham and Women’s Hospital suggested, in CBS’s words, “risk factors for stroke, such as obesity, high blood pressure, an irregular heartbeat and diabetes may for some reason affect women differently than men.” HealthDay (8/9, Reinberg) reports Dr. Madsen, the lead researcher, said, “We also found that the declining rates of stroke in men are primarily driven by a decrease in ischemic strokes, a specific type of stroke caused by a lack of blood flow to the brain as a result of blocked arteries or clots.” In contrast, rates for hemorrhagic stroke “remained stable for both women and men, the study found.”
Study suggests blood pressure fluctuations linked to dementiaReuters (8/7, Rapaport) reports a study of 1,674 older adults published in Circulation found that “people with the most variations in blood pressure,” which was measured through a month of home blood pressure readings, “were more than twice as likely to develop dementia” within the next five years. While the study didn’t address causation, lead study author Tomoyuki Ohara, MD, of the Graduate School of Medical Sciences at Kyushu University in Fukuoka City, said, in Reuters’ words, “it’s possible that daily variation in blood pressure might cause changes in the brain’s structure and function that contribute to the development of dementia.” Costantino Iadecola, MD, director of the Feil Family Brain and Mind Research Institute at Weill Cornell Medicine in New York wrote in an accompanying editorial that, in Reuters’ words, “fluctuations in blood pressure could be a symptom of cognitive decline in progress rather than a risk factor for developing dementia in the future.”
Million Hearts® EHR Optimization Guides help health care professionals leverage their EHR systems to excel in the ABCS. Through helpful step by step instructions, the Guides illustrate how providers can use their EHR products to find, use and improve data on the Million Hearts® clinical quality measures. Ultimately, these guides facilitate the identification of at-risk patients, helping clinical teams across the country protect their patients from heart attacks, strokes and other cardiovascular events. Allscripts [PDF - 1.6 MB] Cerner [PDF - 1.4 MB] NextGen [PDF - 1.1 MB]
ONC encourages all EHR vendors to collaborate with us on developing additional Million Hearts® EHR Optimization Guides. For more information about developing your own Guide for HealthIT.gov, please contact us. Let’s work together towards improving the heart health of millions of Americans!
Statin guidelines may uniquely impact black patientsBlack individuals are at a higher risk of cardiovascular disease than the general population, but whether those individuals receive statins to lower their cholesterol and stave off heart problems might depend on the guidelines their doctors are following. In 2013, the American College of Cardiology and the American Heart Association rolled out new guidelines for statin use that broadened the scope of patients who might benefit from the drugs. More recently, though, the US Preventative Services Task Force released guidelines that focused on the use of statins in a much more narrow group.In a new analysis using data from the Jackson Heart Study, cardiologists conclude that the difference between those two sets of guidelines might be disproportionately affecting African-Americans
Sodium Consumption and Heart HealthReuters (8/2, Rapaport) The typical American adult consumes enough salt each day to damage their heart muscle, reports research published in the Journal of the American College of Cardiology. "The amount of salt a typical American adult consumes” daily “may be enough to damage the heart muscle and make it harder to pump blood.” The study indicated that half of the participants consumed at least 3.73 grams of sodium each day. Investigators found that “compared with adults who ate less sodium, people who consumed more than 3.7 grams of sodium a day were more likely to have enlargement in the left chambers of the heart that are responsible for pumping oxygen-rich blood into the body.” These people “were also more likely to have signs of muscle strain in the heart that can precede structural damage.”
Amount Of Salt In Packaged Food And Drinks Has Declined Reuters (6/5, Seaman) reports that while “packaged foods and store-bought drinks are blamed for adding a lot of salt to US diets,” research published in JAMA Internal Medicine “suggests those foods and beverages don’t contain as much sodium as they once did.” HealthDay (6/5, Reinberg) reports that the “survey of more than 172,000 households found that between 2000 and 2014 the amount of salt in the packaged food and drinks people bought was reduced by nearly 400 milligrams (mg) a day, dropping from more than 2,300 mg to less than 2,000 mg” daily. Meanwhile, “the salt content of packaged foods consumers purchased decreased 12 percent, said lead researcher Jennifer Poti.”
Improve Your Quitline Iowa Referral Rate!As a health care provider, you play an important role in your patients’ well-being and overall health. For patients who use tobacco and nicotine products, you are an important source of information and support in their cessation efforts. QuitlineIowa provides you with the resources you need to help your patients quit and lead a healthier lifestyle. There are two easy ways to refer patients to Quitline Iowa, by giving your patient the phone number 1.800.QUITNOW (1.800.784.8669) or by visiting www.quitlineiowa.org and filling out a web referral. There is also a fax form you can download and print for easy referrals as well. Finally, there is a free Provider training, where you may receive 1 CEU.
Visit http://iowa.quitlogixeducation.org to view the Ask, Advise and Refer training today!
Cholesterol Education Monthwww.cdc.gov/cholesterol_education_month.htm
Healthy Aging Monthhttps://healthyaging.net/september-is-healthy-aging-month/
Nursing Professional Development WeekSeptember 24-30, 2017 www.anpd.org
Pharmacist’s Monthwww.pharmacist.com
Physician Assistants WeekOctober 6-1, 2017 www.aapa.org
Healthcare Environmental Services WeekSeptember 10-16, 2017 www.ahe.org
Patient-Centered Care Awareness Monthwww.planetree.org
Video: The Role of Value-Based CareWhat does successful value-based care look like? Dr. Charles Fazio, Medical Director of HealthPartners, describes a system in which a team of doctors connects with patients on their terms to deliver cost-effective care. Watch the video.
The Iowa Department of Public Health -- Health Promotion and Chronic Disease Control Partnership
Terry Y. MeekHealth Systems Coordinator
Laurene HendricksLinkage Coordinator
Editors:
This e-Bulletin is supported by Cooperative Agreement Number 5U58DP004807-05 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Iowa Department of Public Health.
QPP hardship exception applications for 2017 transition year now being acceptedEligible clinicians and groups participating in the 2017 transition year for the Quality Payment Program under the Merit-Based Incentive Payment System may apply for the EHR Incentive Program Hardship Exception through Oct. 1, according to the CMS. Applications for hardship exemption can be filed based on lack of control over certified EHR technology availability, inadequate internet connectivity or "extreme and uncontrollable circumstances.“ EHR Intelligence (8/4)
Review of Sucralose Safety PublishedA comprehensive review to evaluate the safety of the no-calorie sweetener sucralose confirms studies' findings that sucralose is safe. The review looks at growth, development, reproduction and many other outcomes. A summary, video and link to the publication are here.
CMS gives hospitals more time to meet stage 3 MU requirementsThe CMS issued a final rule giving hospitals one more year to use the 2014 Edition of Certified EHR Technology software. The rule also says hospitals will not have to meet stage 3 meaningful use requirements for EHRs until 2019. Health Data Management (8/3)
Report ranks states according to EHR adoption, e-prescribingThe Center for Data Innovation ranked all 50 states based on EHR adoption and electronic prescribing and found that Massachusetts had EHR adoption rates of 90 percent among physician practices and 93 percent among hospitals, followed by Indiana, Minnesota, Washington and Wyoming, while Hawaii, Louisiana, New Jersey, Rhode Island and Vermont were in the bottom five. New York leads in e-prescribing, with electronic prescriptions for 37.7 percent of controlled substances, followed by Nebraska with 20.2 percent. FierceHealthcare (8/1)
Study: A1C alone underdiagnoses prediabetes, diabetes with obesityBelgian researchers compared the performance of A1C testing and oral glucose tolerance testing among 1,241 overweight and obese Caucasian individuals and found 44 percent of prediabetes patients and 47 percent of those with diabetes diagnosed by OGTT would have been missed if A1C testing alone was used. The findings in the International Journal of Obesity revealed A1C testing had an overall accuracy of 62 percent at a cutoff point of 5.7 percent for diagnosing prediabetes and an overall accuracy of 87 percent at a cutoff point of 6.5% for diabetes. Medscape (free registration)/Reuters (8/4)
JAMA Cardiology: Changes In Medication Use And Adherence In Accountable Care OrganizationsIn this population-based study of Medicare beneficiaries from before the start of accountable care organization contracts to 2014, ranging from approximately 4.5 million to 10.8 million person-years, depending on drug class, differential changes in the use of and adherence to common antihypertensive, lipid-lowering, and hypoglycemic medications were minimal for accountable care organization patients vs patients of non–accountable care organization providers. Through its third year of operation, the Medicare Shared Savings Program has not meaningfully increased the use of or adherence to medications that improve outcomes for patients with cardiovascular disease or diabetes. (McWilliams, Najafzadeh, Shrank et al, 7/12)
