Objectives: To compare rates of eye care visits and vision impairment among working-age adults with vision insurance vs without, among the total sample of Behavioral Risk Factor Surveillance Survey respondents and among a subsample of respondents who had diagnoses of glaucoma, age-related macular degeneration (ARMD), and/or cataract. Design: Using the Behavioral Risk Factor Surveillance Survey 2008 vision module data, we examined the likelihood of an eye care visit within the past year and of selfreported visual impairment among 27 152 adults aged 40 to 65 years and among a subset of 3158 persons (11.6%) with glaucoma, ARMD, and/or cataract. Multivariate logistic regression models were used. Results: About 40% of both the study population and the subsample with glaucoma, ARMD, and/or cataract had no vision insurance. Respondents with vision insurance were more likely than those without to have had eye care visits (general population adjusted odds ratio [AOR], 1.90 [95% CI, 1.89-1.90]; glaucoma-ARMD-cataract subsample AOR, 2.15 [95% CI, 2.13-2.17]), to have no dif-ficulty recognizing friends across the street (general population AOR, 1.24 [95% CI, 1.22-1.26]; eye-disease subsample AOR, 1.45 [95% CI, 1.42-1.49]), and to have no difficulty reading printed matter (general population AOR, 1.34 [95% CI, 1.33-1.35]; eye-disease subsample AOR, 1.37 [95% CI, 1.34-1.39]). Respondents from the total sample who had an eye care visit were better able to recognize friends across the street (AOR, 1.07) and had no difficulty reading printed matter (AOR, 1.70), and respondents from the eye-disease subsample who had an eye care visit also were better able to recognize friends across the street (AOR, 1.71) and had no difficulty reading printed matter (AOR, 1.45).Conclusions: Lack of vision insurance impedes eye care utilization, which, in turn, may irrevocably affect vision. Vision insurance for preventive eye care should cease to be a separate insurance benefit and should be mandatory in all health plans.

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This study evaluated the efficiency, effectiveness, and racial disparities reduction potential of Screening Colonoscopies for People Everywhere in South Carolina (SCOPE SC), a state-funded program for indigent persons aged 50–64 years (45–64 years for African American (AA)) with a medical home in community health centers. Patients were referred to existing referral network providers, and the centers were compensated for patient navigation. Data on procedures and patient demographics were analyzed. Of 782 individuals recruited (71.2% AA), 85% (665) completed the procedure (71.1% AA). The adenoma detection rate was 27.8% (males 34.6% and females 25.1%), advanced neoplasm rate 7.7% (including 3 cancers), cecum intubation rate 98.9%, inadequate bowel preparation rate 7.9%, and adverse event rate 0.9%. All indicators met the national quality benchmarks. The adenoma rate of 26.0% among AAs aged 45–49 years was similar to that of older Whites and AAs. We found that patient navigation and a medical home setting resulted in a successful and high-quality screening program. The observed high adenoma rate among younger AAs calls for more research with larger cohorts to evaluate the appropriateness of the current screening guidelines for AAs, given that they suffer 47% higher colorectal cancer mortality than Whites.

BackgroundOur objective is to estimate the effects associated with higher rates of renin‐angiotensin system antagonists, angiotensin‐converting enzyme inhibitors and angiotensin receptor blockers (ACEI/ARBs), in secondary prevention for geriatric (aged >65 years) patients with new ischemic strokes by chronic kidney disease (CKD) status.Methods and ResultsThe effects of ACEI/ARBs on survival and renal risk were estimated by CKD status using an instrumental variable (IV) estimator. Instruments were based on local area variation in ACEI/ARB use. Data abstracted from charts were used to assess the assumptions underlying the instrumental estimator. ACEI/ARBs were used after stroke by 45.9% and 45.2% of CKD and non‐CKD patients, respectively. ACEI/ARB rate differences across local areas grouped by practice styles were nearly identical for CKD and non‐CKD patients. Higher ACEI/ARB use rates for non‐CKD patients were associated with higher 2‐year survival rates, whereas higher ACEI/ARB use rates for patients with CKD were associated with lower 2‐year survival rates. While the negative survival estimates for patients with CKD were not statistically different from zero, they were statistically lower than the estimates for non‐CKD patients. Confounders abstracted from charts were not associated with the instrumental variable used.ConclusionsHigher ACEI/ARB use rates had different survival implications for older ischemic stroke patients with and without CKD. ACEI/ARBs appear underused in ischemic stroke patients without CKD as higher use rates were associated with higher 2‐year survival rates. This conclusion is not generalizable to the ischemic stroke patients with CKD, as higher ACEI/ARBS use rates were associated with lower 2‐year survival rates that were statistically lower than the estimates for non‐CKD patients.

In this study, we explore the needs of different valuable customer groups for service quality and how limited resources are allocated to enhance service quality. Accordingly, we propose a hybrid multi-criteria decision-making (MCDM) tool that uses fuzzy synthetic evaluation (FSE) in combination with the analytic hierarchy process (AHP) to help companies enhance understanding of quantitative data (the weights of the factors that affect service quality) and qualitative information to identify valuable customers. Fifty-three experts and 304 consumers at convenience stores (CVS) comprise the data set. We employed the AHP to obtain index weights in the second step of FSE and conducted FSE to determine the importance of various valuable customer groups. The results demonstrate that different valuable customer groups have dissimilar perceptions and feelings about service quality. The findings indicate that customers between “20 to 29 years old” are the most valuable customer group and that most consumers do not care much about “problem solving”. The analysis is distinct from extant work in that it examines the effect of receiving service quality from a consumer viewpoint, as we conducted a comprehensive analysis from both customer and expert perspectives.