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Month: May 2017

NCQA Patient-Centered Medical Home: Updated & Upgraded

 The National Committee for Quality Assurance (NCQA), an independent non-profit organization that works to improve health care quality, has recently given its patient-centered medical home ‘a makeover’ in order to “reduce documentation burdens, lower costs, and facilitate quality improvements.”

The NCQA’s move marks a growing effort spearheaded by the healthcare industry’s leadership organizations in response to new technologies, uncertainty surrounding reimbursements, and heightened reporting requirements. The organization’s recent announcement of a comprehensive overhaul will enact changes that aim to create “a much more user-friendly version of the popular practice transformation framework that avoids the pain points of previous iterations of the program,” said Michael S. Barr, MD, Executive Vice President of the Quality Measurement and Research Group at NCQA.

Due to a host of complaints from physicians and providers regarding the ‘unduly onerous’ recognition process, the NCQA wishes to reduce or eliminate costs, lower documentation burdens, and streamline some of the aspects of the recognition process that were devaluing patient care. A marked change is the abolition of distinctions between Level 1, 2, and 3; providers are now recognized or working towards recognition. The NCQA and healthcare industry realizes that ‘all-or-nothing measurements’ are not the optimal, most effective way to encourage innovation and improvement.

Moreover, the NCQA has replaced the three-year recertification cycle with annual check-ins, so that providers are not required to go through the entire recognition process again. Yearly meetings are designed to ensure that recognized practices are primarily focused on a high level of patient-centered care, and continuously improving. Each practice will also be assigned an NCQA representative, who can assist them in moving throughout the process, and also confirm and certify that the practice has met the necessary requirements.

Barr hopes that the revamped PCMH recognition process will help providers move towards a more efficient, effective way to deliver care, but admits that they will need more than yearly check-ins to succeed in an increasingly data-driven world. He urged stakeholders that it is time to “optimize electronic health records (EHRs), so that we can really align them with what we need to do to improve patient care.” Barr further clarifies that EHRs should be redesigned in order to effectively communicate the patients’ stories, and simultaneously equip providers with the necessary data to make informed, personalized, and effective choices with the patient and caregivers.

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Heart Disease: #1 Killer Worldwide

New research published in the May 17 issue of the Journal of the American College of Cardiology indicates that roughly a third of all global deaths are the result of heart disease and stroke: cardiovascular disease is currently the number one killer around the world.

Gregory Roth, the study’s lead author and assistant professor of cardiology at the University of Washington School of Medicine, notes that the statistics present “an alarming threat to global health…trends in cardiovascular disease mortality are no longer declining for high-income regions, and low- and middle-income countries are also seeing more cardiovascular disease related deaths.”

The accumulation of research assessed current international rates of a variety of types of heart disease, including stroke, coronary heart disease, atrial fibrillation, and peripheral arterial disease. The highest rates of disease were in countries across sub-Saharan Africa, Centrla Asia, and eastern and central Europe. The lowest incidence of heart disease was found in wealthy Asian nations, including Singapore, Japan, and South Korea.

Nevertheless, approximately 18 million people across the globe died from heart disease in 2015; researchers stated that over 400 million men and women have a kind of cardiovascular illness. High levels of cardiovascular disease are seen both in high-income countries, and in regions with more limited access to effective, inexpensive treatments.

Dr. Roth notes that the risk factors for heart disease—high blood pressure, poor diet and high cholesterol, excessive smoking and drinking, and obesity—are common throughout the world. “Now we need to find innovative ways to deliver our low-cost, effective treatments to the hundreds of millions of people who can’t access them.”

These findings should present opportunities for public health officials across local, national, and international levels to collaborate and share strategies on how to address the aforementioned risk factors.

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Non-O Blood Types: Higher Heart Attack Risk?

Research suggests that those people with a non-O blood group have a slightly increased risk of cardiovascular disease: specifically, heart attack and stroke.

The research analyzed studies involving 1.3 million people; the data was presented at the European Society of Cardiology. The data found that 15 in1,000 people with a non-O blood group suffered a heart attack, compared to 14in 1,000 people with the O blood group. While the increase seems small, ‘when applied to a whole population the numbers become more important.’

Scientists suggest that these findings can be attributed to the fact that people with A, B, and AB blood have higher levels of a blood-clotting protein. Previous research has found that people with AB blood, the rarest type, are 23%more likely to suffer heart disease—the most vulnerable population.

Notwithstanding the findings, most cardiologists and physicians agree that a person’s risk estimation for cardiovascular disease is primarily determined by age, genetics, and other modifiable factors including nutrition and diet, and level of physical activity.

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Calling All Cheese Lovers

A large-scale analysis indicates that cheese, and other dairy products, do not lead to an increased risk of death from heart disease or stroke.

A study published in the European Journal of Epidemiology involving scientists at the Institute for Food, Nutrition, and Health at the University of Reading, England analyzed 29 studies that collectively represented almost 1 million people and 93,000 instances of death.

Within the studies, the team focused on diet—specifically, whether or not participants consumed large amounts of dairy products—and the rates of CVD, coronary heart disease, and death.

The conclusions and findings showed no correlation or association between a diet high in dairy and risk of heart disease, combining data from 29 prospective cohort studies.

One of the study’s authors, Jing Guo, stated that this latest analysis provides “further evidence that a diet high in dairy foods is not necessarily damaging to health.” The evidence supports previous findings that demonstrate the health benefits of dairy foods in an integrated, well-balanced diet.

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Risk of Heart Disease with Painkillers

A large-scale study several years ago indicated that common painkillers like ibuprofen and naproxen are considered risky for people who have had heart attacks. New research indicates that the risk can begin within the first week of usage.

The study involved NSAIDs: non-steroidal anti-inflammatory drugs, including ibuprofen—generically known under its brand names Advil and/or Motrin.Researchers at McGill University pooled extensive studies and clinical research on NSAIDs and heart attacks, using a data pool of over 446,000 people who used the drugs, including 385,000 participants who did not have heart attacks.

The report, published in the British Medical Journal, stated that current use of a NSAID is “associated with a significantly increased risk of acute myocardial infarction,” the medical terminology for a heart attack. Moreover, the risk began within a week of usage. The data demonstrated that those who used NSAIDs were more likely to have a repeat heart attack, or die within the next 5 years. In the first year post-heart attack, 20 percent of NSAID users died, compared to approximately 12 percent of non-users. The death rate of NSAID users remained about double than that of non-users in the next few years.

A number of studies have consistently revealed similar patterns concerningNSAIDs and heart disease, coupled with biological reasons that NSAIDs could be risky for people with heart disease. Evidence suggests that the drugs may impact and affect blood clotting, blood vessel function, and blood pressure.Because NSAIDs are available over the counter, many patients and consumers believe that there is no danger involved.

The U.S. Food and Drug Administration has already added ‘black box warnings’ to NSAIDs, warning people with higher risks for heart disease and blood pressure to avoid using them without the recommendation of a physician. Dr. Gordan Tomaselli, chief of cardiology at Johns Hopkins University, advises: “if you’ve ever had a heart attack, you should use NSAIDs with caution.”

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Type 2 Diabetes and Heart Failure: A Deadly Combination

An in-depth session titled “Heart Failure: The Frequent, Forgotten, and Often Fatal Complication of Type 2 Diabetes” was presented last week at the American Association of Clinical Endocrinology’s 26th Annual Scientific and Clinical Congress. The cited evidence and research pointed to a high frequency of heart failure, accompanied by an increased risk of mortality, for patients with diabetes.

The conclusion that heart failure requires increased scrutiny, as a risk factor and complication of type 2 diabetes, has been oft quoted and researched—yet it is still not widely known how common the condition is. While microvascular effects of type 2 diabetes are well known and understood—such as neuropathy and diabetic retinopathy—and macrovascular conditions including stroke and peripheral vascular disease, heart failure almost inevitably raises mortality.

Researchers at the University of Alabama at Birmingham School of Medicine have performed series of clinical trials in an effort to determine whether or not heart failure should be more rigorously treated, in order to alleviate and mitigate the poor outcomes often seen in patients. Conclusions indicate that between 40 and 45 percent of patients with diabetes in the United States suffer from heart failure, vs. 12 percent of non-diabetes.

David S.H. Bell, MD showcased studies that specifically assessed and evaluated the complex effects of diabetes and contributing factors to the three primary causes of the heart failure, while other physicians highlighted relations between glycemic control and heart failure risk—focusing on strong correlations between the high incidence of heart failure and type 2 diabetes. Other researchers pointed to the fact that autonomic system dysfunction, a predictor of cardiovascular risk, often occurs in pre-diabetes—which might offer opportunities for early intervention. Technological advancements of the past decade currently allow for identification of the early stages of autonomic dysfunction, through the utilization of concrete, tangible standardized measurements.

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Air Pollution & Traffic: Environmental Impacts on the Heart

Recent findings that are part of the Multi-Ethnic Study of Atherosclerosis, an ongoing examination in six U.S. communities of the lifestyle factors that predict development of cardiovascular disease, indicate that traffic-related air pollution may increase heart disease risk by lowering levels of so-called “good” cholesterol.

In a study of 6,654 middle-aged and older adults from diverse ethnic backgrounds, participants living in areas with high air pollution levels tended to have lower high-density lipoprotein, or HDL, levels.Researchers also found men and women responded to air pollutants differently:The HDL was lower at higher pollution exposure for both sexes, but the difference was greater in women.

The link between air pollution and an increase in cardiovascular disease is not new. In 2004, an American HeartAssociation scientific statement concluded exposure to air pollution contributes to cardiovascular illness and death. A 2010 update elaborated on those risks.
But this new study begins the work at understanding the biology behind the link.
It is the first large study to examine associations between air pollution and HDL particle number, said lead author Griffith Bell, Ph.D.,from the University of Washington School of Public Health in Seattle. The study was published in the journal Arteriosclerosis, Thrombosis, and VascularBiology.

The pollution-heart disease connection may be explained by a reduction in the number of small, cholesterol-depleted HDL particles, which leaves the average amount of cholesterol in HDL particles higher on aper-particle basis. Recent evidence suggests that the number and functionality of HDL particles may be a better gauge of HDL’s heart-healthy effects than their cholesterol content, Bell said.

HDL is known as “good” cholesterol because it helps remove other forms of cholesterol from the bloodstream. Experts believe HDL acts as a scavenger, carrying LDL – or “bad” – cholesterol away from the arteries and back to the liver, where it is broken down and passed from the body.

Researchers found:
–Higher exposure to black carbon, a marker of traffic-related pollution, averaged over a year was significantly associated with a lower level of “good” HDL cholesterol.
–Higher particulate matter exposure over three months was associated with a lower HDL particle number.
–Changes in HDL levels may already appear after brief and medium-length exposures to air pollution.

More and more researchers are examining air pollution and its effects on the heart.
In February, researchers at the University of California, Los Angeles, found that exposure to pollution caused mice to experience changes in the normal composition of gut bacteria. The changes, according to their study published in the journal Nature, promoted the circulation of cholesterol in the bloodstream, and that, in turn, promoted the formation of plaque in the arteries, known as atherosclerosis.

Many previous studies on the health effects of air pollution assumed people living in the same city have the same level of air pollution exposure. But this new study used cohort-focused monitoring campaigns looking at time and place to estimate air pollution exposure for each study participant, Bell said.

This study measured HDL particle numbers, so “we were unable to examine whether they changed over time,” Bell said. That means more study is needed. Continuing to track how HDL levels change with extent of exposure to traffic air pollution and investigating how air pollution interferes with HDL’s activity in the body will help confirm and understand the role of HDL.

“Our study helps strengthen the biological plausibility of the link between traffic-related air pollution and cardiovascular disease,” he said. “We’re slowly beginning to understand some of the biology of how that link works.”

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The Benefits of Bicycling

A recent study at the University of Glasgow, published in the British Medical Journal, indicates that those people who bicycle to work are 41 percent less likely to develop heart disease and cancer. While walking has clearly outlined benefits, it does not provide the same payback as bicycling.

The test was conducted with 264,337 people; compared to driving, cycling is linked to a 46 percent lower risk of cardiovascular disease. The same study demonstrated that walking reduced heart disease by 27 percent, but showed no links between lower risks of cancer or premature death.

Researchers and experts believe that the high health benefits of cycling may be linked to the fact that cyclists often travel longer distances, and exercise at higher intensities.

Dr. Jason Gill, a professor and scientist who helped execute the study, believes that the government should legislate easier ways for people to commute by bike, including the creation of “cycle lanes, city bike hire, subsidized cycle purchase schemes, and increasing provision for cycles on public transport.” These efforts have the potential to create significant opportunities for improvement of public health.

Perhaps most importantly, it is imperative to make physical activity both ‘easier and more accessible.’ Workplaces, local authorities, and the legislature should investigate ways to increase and enhance public transport—making it an ‘easy option’ to get to work.

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