Effect of smoking cessation advice on cardiovascular disease.

Performance measures and guidelines encourage physicians to advise smokers to quit. The effect of these efforts on the morbidity, mortality, and cost of cardiovascular disease is not known. This article analyzes the effects of offering smoking cessation advice in the US population. The Archimedes model is used to simulate several clinical trials in which basic advice and medication advice are offered and to calculate the rates of myocardial infarctions, congestive heart disease deaths, strokes, life years, quality-adjusted life years (QALYs), costs, and cost/ QALY. The simulated population is a representative sample of the US population drawn from the Third National Health and Nutrition Survey conducted just before the performance measures and guidelines were introduced. The results show that offering basic advice and medication advice can prevent about 13% and 19% of myocardial infarctions and strokes, respectively. The 30-year cost/QALY is approximately $3000 less than the base-case assumptions and less than $10 000 under pessimistic assumptions.

Gender and racial disparities in the management of diabetes mellitus among Medicare patients.

BACKGROUND: Racial/ethnic disparities in diabetes care have been demonstrated in several settings, but few studies have evaluated whether racial/ethnic differences vary by gender. The objective of this study is to understand gender and racial effects on diabetes care for Medicare managed care beneficiaries. METHODS: Using data from: (1) Healthcare Effectiveness Data and Information Set (HEDIS); (2) Medicare Enrollment Files; and (3) U.S. Census, hierarchical generalized linear analyses were conducted to model the six HEDIS comprehensive diabetes care quality indicators, including processes of care and intermediate outcome measures, as a function of gender and race/ethnicity. RESULTS: Women were more likely to have received HbA(1c) screening or eye examination, but less likely to have LDL control at <100 mg/dL, compared to men. Racial disparities favored whites in five measures, where African Americans were less likely to have received HbA(1c) screening, eye examination, cholesterol screening, or achieve adequate HbA(1c) control or LDL control at <100 mg/dL. Enrollees in managed care plans where African Americans constituted more than 20% of their insured population tended to have lower likelihood of meeting the HbA(1c) screening, HbA(1c) control, and eye examination measures. CONCLUSIONS AND DISCUSSION: Gender and racial disparities in performance indicators were present among persons enrolled in Medicare managed care. White women were more likely to have met the performance measures related to process of care, but African Americans fared worse in both process of care and intermediate health outcome measures, compared to their white counterparts. Poor performance in cholesterol control observed in women of both races suggests the possibility of less intensive cholesterol treatment in women. The differences in the pattern of care demonstrate the need for interventions tailored to address gender and race/ethnicity.