Jane E. Sisk

Cost Effectiveness of Vaccination Against Pneumococcal Pneumonia: An Update

We updated a 1978 cost-effectiveness analysis of vaccination against pneumococcal pneumonia in light of the introduction in 1983 of a 23-valent vaccine, recent medical literature, and different relative prices of medical services. Although other base-case assumptions have remained reasonable, the low estimates of 10% of pneumonia as pneumococcal and a 3-year duration of immunity now appear more likely. Vaccination of a person age 65 or older could gain a year of healthy life for about

GRADE guidelines: 10. Considering resource use and rating the quality of economic evidence

6000 in 1983 dollars. Medicare has covered pneumococcal vaccination since 1981. With the revised assumptions, net Medicare expenditures ranged from about

How do Urban African Americans and Latinos View the Influence of Diet on Hypertension

5.50 to

Collecting Adequate Data On Racial And Ethnic Disparities In Health: The Challenges Continue

10.50 per vaccination, or from

Use Of Medical Care For Chronic Conditions

4400 to

Challenges Facing Nurse-Led Disease Management for Heart Failure

8300 per year of healthy life gained. Vaccination of an elderly person would almost break even, if duration of immunity were 8 years and would be cost saving if the vaccine were administered under a public program. Current levels of vaccination appear too low considering the potential health benefits and cost-effectiveness.

Trends in diabetes treatment patterns among primary care providers.

OBJECTIVES In this article, we describe how to include considerations about resource utilization when making recommendations according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. STUDY DESIGN AND SETTINGS We focus on challenges with rating the confidence in effect estimates (quality of evidence) and incorporating resource use into evidence profiles and Summary of Findings (SoF) tables. RESULTS GRADE recommends that important differences in resource use between alternative management strategies should be included along with other important outcomes in the evidence profile and SoF table. Key steps in considering resources in making recommendations with GRADE are the identification of items of resource use that may differ between alternative management strategies and that are potentially important to decision makers, finding evidence for the differences in resource use, making judgments regarding confidence in effect estimates using the same criteria used for health outcomes, and valuing the resource use in terms of costs for the specific setting for which recommendations are being made. CONCLUSIONS With our framework, decision makers will have access to concise summaries of recommendations, including ratings of the quality of economic evidence, and better understand the implications for clinical decision making.

Cost-Effectiveness of Nurse-Led Disease Management for Heart Failure in an Ethnically Diverse Urban Community

Uncontrolled hypertension and its complications continue to be major health problems that disproportionately affect poor minority communities. Although dietary modification is an effective treatment for hypertension, it is not clear how hypertensive minority patients view diet as part of their treatment, and what barriers affect their abilities to eat healthy diets. We conducted nine focus groups with 88 African American and Latino patients treated for hypertension to assess their knowledge, attitudes, behaviors, and beliefs concerning hypertension. Participants generally agreed that certain foods and food additives play an important role in the cause and treatment of hypertension. However, they found clinician-recommended diets difficult to follow in the context of their family lives, social situations, and cultures. These diets were often considered expensive, an unwelcome departure from traditional and preferred diets, socially isolating, and not effective enough to obviate the need for medications. These findings suggest the importance of culturally sensitive approaches to dietary improvements.

Electronic Medical Record/Electronic Health Record Use by Office- based Physicians: United States, 2008 and Preliminary 2009

Data limitations continue to pose challenges for efforts to identify racial and ethnic disparities in health and health care and analyze the underlying causes. Given budget constraints, the most feasible federal strategies to improve national data are those requiring only modest expenditures. Collaborations among private and public stakeholders hold promise for improving estimation methods and assessing disparities among small populations.

Preliminary Estimates of Electronic Medical Record Use by Office-based Physicians: United States, 2008

We used nationally representative data from the National Center for Health Statistics to compare 1995-96 and 2005-06 ambulatory care visit and 1996 and 2006 hospital discharge rates for adults for eight major chronic conditions. For the eight conditions combined, ambulatory care visit rates rose 21 percent, while hospital discharge rates fell 9 percent. Discharge rates fell for heart disease, cancer, and cerebrovascular disease. Ambulatory care visit rates rose at least 30 percent for arthritis, hypertension, diabetes, and depression. Medicaid recipients and black adults obtain more of their ambulatory care in hospital emergency and outpatient departments and less in physician offices than others do.