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MAY 2007 HOT TOPICSGender Disparities in Quality of Care for Cardiovascular Disease and Diabetes
Cardiovascular disease (CVD) and diabetes are two of the leading causes of illness and death among Americans. These diseases afflict men and women in nearly equal numbers; yet, there is growing evidence that women are less likely than men to receive recommended care or achieve desired outcomes. Congress is continuously working to reduce health disparities, but little is known about gender differences in ambulatory care, such as screening, treatment with medication, and control of risk factors. A study led by RAND's Chloe Bird and Allen Fremont examined whether there are gender disparities in quality of care for CVD and diabetes in managed care settings. Using data on both privately insured and Medicare-insured patients, the study assessed differences in men's and women's care across 11 quality measures—seven for processes of care and four for outcomes. The results showed significant gender disparities for several of these measures, controlling for race and socioeconomic status. For example, among both Medicare-insured and privately insured patients with diabetes, women were 16 percent less likely than men to achieve control of cholesterol. Among Medicare cardiac patients, women were 22 percent less likely than men to achieve control of cholesterol. In addition, after a cardiac event, privately insured women were 15 percent less likely than men to receive the recommended medication (a beta blocker). Given that women typically seek medical care more frequently than men, such disparities are surprising and suggest the need for further examination of their underlying causes. These results also underscore the need for better monitoring of gender differences in the quality of CVD and diabetes care if national goals of reducing disparities and improving outcomes are to be achieved.
Read More »Defining and Measuring Public Health Emergency Preparedness
Since the terrorist attacks of September 11, 2001, the federal government has spent more than $5 billion to improve the nation's ability to respond to large-scale public health emergencies. Yet the absence of a common definition of preparedness has hindered attempts to assess whether this investment has improved the nation's preparedness for emergencies such as bioterrorist attacks or pandemic flu. To help address this problem, RAND convened a panel of experts led by former Virginia Governor James Gilmore III. The panel proposed the following definition of public health emergency preparedness: “The capability of the public health and health care systems, communities and individuals to prevent, protect against, quickly respond to and recover from health emergencies, particularly those whose scale, timing or unpredictability threatens to overwhelm routine capabilities.” Along with this definition, the panel emphasized the importance of exercising emergency response plans, engaging the public as active participants in preparedness, and building on preexisting public health systems. Additionally, the panel provided a number of concrete, measurable actions that communities should take to be prepared, including (1) instituting a coordinated rapid-response capability that includes well-defined roles for officials and the public, a clear command structure, strong public communication, the ability to deliver emergency health care to large numbers of people, and the ability to monitor the spread of a public health emergency; (2) developing and maintaining adequate numbers of operations-ready public health workers and volunteers; and (3) engaging in a continuous process of testing, improving, and maintaining systems for tracking and reporting information on readiness to decisionmakers and the public. The panel's deliberations were intended to provide a solid footing for the development of clear and coherent standards and metrics that the U.S. public health system needs to maintain preparedness and accountability to the public. Read More »More Research on Public Health Preparedness » |
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RAND Health conducts objective research on health, health behavior, and health policy. Access to all RAND Health research is available at www.rand.org/health/. The RAND Corporation is a nonprofit research organization providing objective analysis and effective solutions that address the challenges facing the public and private sectors around the world. Learn More »Copyright © 2007 RAND Corporation. 1776 Main Street, Santa Monica, CA 90401-3208. RAND® is a registered trademark. The RAND Health Congressional Newsletter is distributed on an opt-in basis only by visiting us at www.rand.org. We respect your privacy. If you do not wish to receive this periodic newsletter, please email ocr@rand.org or call (703) 413-1100 x5395. This newsletter is also available on the RAND Congressional web site » |
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