Caitlin Donato and Christine Patton-Mitchell
July 26, 2010
PHC 6000 – Epidemiology Case Study: Smoking and Coronary Heart Disease
We pledge that we have not plagiarized on any aspect of this assignment.
Executive Summary
Smoking plays a predominant role as one of the risk factors of coronary heart disease. As tobacco use is viewed as both a significant contributing factor but also a modifiable factor, removing this risk factor from the CHD equation is very important to healthcare. Smokers are 2 to 4 times more likely to develop CHD (AHA, 2010b, paras 5 & 7). From a monetary standpoint, smoking is a costly habit as well. A managed care organization can pay as much as 40 percent higher healthcare costs for a smoker than a nonsmoker (Barendregt, Bonneux, & Van Der Maas, 1997, p. 1052).
This case study will take a close look at a smoking cessation program offered by a hypothetical managed care organization called Happy HMO. Outlined below and discussed in detail, this case study will examine the health effectiveness and cost effectiveness for Happy HMO to offer a smoking cessation program.
Health Effectiveness
Smoking programs are successful in getting about ten percent of participants to quit. They are estimated to add 7.1 years of life to every person who quits smoking. For the small percentage of smokers who quit from these programs they are tremendously effective. Once a smoker quits they begin to see immediate health benefits. One benefit of smoking cessation is the reduced risk of coronary heart disease. From the health stand point of Happy HMO; smoking cessation programs are an effective method.
Cost Effectiveness
In terms of lowering Happy HMO’s cost and liability, offering a smoking cessation is not the best option. Cessation programs will cause members to live longer, but along with older age comes age related illnesses. Age related illnesses have proven to be more expensive than smoking related illnesses and will therefore, increase healthcare costs for Happy HMO in the long run.
Overview/Background:
Smoking plays a predominant role as one of the risk factors of coronary heart disease. As tobacco use is viewed as both a significant contributing factor but also a modifiable factor, removing this risk factor from the CHD equation is very important to healthcare.
Tobacco, whether smoked or taken in by breathing secondhand, damages arteries and the heart. It lowers the level of good cholesterol, increases heart rate, and replaces oxygen with carbon monoxide in the blood. Blood clots are more likely to form due to smoking, which can cause heart attacks and strokes (AHA, 2010b, para 1).
Smokers are 2 to 4 times more likely to develop CHD. When looking at those who have CHD, smokers are also 2 to 3 times more likely to die from it than non-smokers. In addition to all of the risks for smokers, it is estimated that annually, 46,000 non-smokers die from coronary heart disease related to exposure to secondhand smoke (AHA, 2010b, paras 5 & 7).
Use:
The CDC reports 2008 cigarette use for adults in the state of Florida at 17.5%. This ranked approximately in the middle, Utah being the lowest at 9.2% and West Virginia (tobacco country) being the highest at 26.6% (CDC, 2010).
2002 data reports specifically for Orange County, Florida, reflect a number higher than the state average with 21% of adults smoking. The age group with the largest number of smokers is 18-44 year olds, which comprised 22.1%. This is also higher than the statewide percentage of 18-44 year olds, which comes in at 15.1%. Teen smoking is also a concern in Orange County where a 2007 study shows 17% of high school students smoked. 60.1% of high school students and 77.2% of middle school students reported they were exposed to secondhand smoke (OCHD, 2010, para 3).
Although tobacco use has decreased over the past ten years with 2007 reports showing a national average of 19.8% of adults smoking, the slow rate of decline makes it highly unlikely that the Healthy People goal of 12% will be met for their 2010 target date once data is finalized (AHA, 2010b, para 8).
Laws and Prevention Programs: Laws
In addition to the large role it plays in regard to CHD, smoking is also considered to be a factor in numerous other health concerns and therefore the subject of a number of federal, state and local laws. In 2009, the Family Smoking Prevention and Tobacco Control Act was signed into law and authorized the Food and Drug Administration to regulate tobacco products in how they are made, marketed, and sold. Highlights of the law include specific restrictions on teen access and marketing. It requires larger warning labels and requires detailed lists of ingredients (Tobacco Free Kids, 2010).
Prevention Programs
Of the 46 million Americans who smoke cigarettes, many are trying to quit. The American Heart Association estimates that more than 49% of adults who have ever smoked have quit. Each year, approximately 1.3 million smokers are able to quit, many with the help of smoking cessation programs (AHA, 2010a).
There are a number of programs on the national and state levels. Smokefree.gov is an online resource guiding people through preparing to quit, quitting, and staying quit (Smokefree, 2010). In 2006, Florida put into law Amendment 4, which formed the Florida Tobacco Education and Use Prevention Advisory Council. It includes elements such as QuitLine, a toll-free telephone based tobacco cessation service (FDOH, 2010).
The Happy HMO Smoking Cessation Case Study:
The University of Michigan’s School of Public Health pooled together data from three separate managed care organizations to study smoking cessation in a hypothetical MCO, which we will call Happy HMO. The data was used to simulate both the financial impact and the cost effectiveness of tobacco cessation (Tokarski, 2004). Following, we will look at the simulated first five years of the cessation program and explore three key questions that discuss whether or not they are successful in getting people to quit smoking, reduction of CHD, and the overall cost effectiveness for Happy HMO.
Program Overview Chart:
During The First 5 Years of
Cessation Program
Size of Happy HMO
450,000
Members who used cessation program
54,488
Members who quit as a result
4,892
Cost incurred by Happy HMO
$15,500,000
Healthcare costs saved
$500,000
(Tokarski, 2004)
Questions: · Are smoking cessation programs successful in getting people to quit smoking? · Does quitting smoking reduce the risk of coronary heart disease? · Are smoking cessation programs a cost effective approach for MCOs?
Answers: Are smoking cessation programs successful in getting people to quit smoking?
Among the members of Happy HMO who participated in the smoking cessation program there was about a 10 percent quit rate, which could be attributed to the smoking cessation program (Tokarski, 2004).
Smoking cessation programs can be successful in causing a small number of people to quit smoking; however, it can often be a result of other factors. For example, it can depend on the smoker’s readiness to quit smoking (Gallo, 2005, p. 1). According to the 1990 Surgeon General Report, smokers who need assistance should have it available (U.S. Department of Health and Human Services, 1990). The smoker who wants to quit and feel that they are ready will have the highest success rate in quitting through a smoking cessation program.
The success rate in smoking cessation programs may appear discouraging; however, more than 90 percent of smokers who attempt to quit smoking without treatment assistance will fail (Southard, 2007, p. 2). Therefore, if a patient is ready to quit smoking then a smoking cessation program is their best option.
There are certain factors within cessation programs that have been proven to yield a higher success rate. One factor is including nicotine replacement or other medication to facilitate cessation. Programs that do not offer nicotine replacements or other medications increase the cessation rate by about six percent over programs that do offer nicotine replacements (Fleming, 2008, p. 359). Another aspect that can increase the successfulness of a program is to have health professional’s recommend the program (Southard, 2007, p. 3).
Does quitting smoking reduce the risk of coronary heart disease?
Smoking cessation has been proven to allow people to live a longer life than continual smokers (U.S. Department of Health and Human Services, 1999, p.1). A smoker’s body will begin a series of changes within minutes of smoking cessation. It only takes 20 minutes after the last cigarette for the smoker’s blood pressure to drop to normal. After just 24 hours of smoking cessation the chances that person will suffer a heart attack already decreases. The person can decrease their excess risk of coronary heart disease to half that of a smoker after one year of quitting (Quit Smoking Support, 1995, para. 2).
Numerous studies have shown a substantial decrease in CHD deaths for former smokers compared to smokers who never quit. Not only will smoking cessation reduce the risk of developing coronary heart disease, but it will also reduce the risk of reoccurring illnesses by as much as fifty percent (Ockene & Miller, 1997, pp.3243-3247). People who quit smoking are less likely to die from smoking related illnesses, regardless of their age (National Cancer Institute, 2007).
Are smoking cessation programs a cost-effective approach for a managed care organization?
If the goal of Happy HMO is to reduce the amount of enrollee’s that smoke, then offering a cessation program is a cost-effective approach. Covering smoking cessation programs have been found to add 7.1 years to a MCO enrollee’s life expectancy. The cost of cessation programs compared to a health plan’s total expenditures is minimal.
There were 54,488 enrollees of Happy HMO that used the covered smoking cessation program in the first five years. As a result 4,892 members quit than would have without coverage. The smoking cessation program resulted in $0.63 per member per month expenditures to Happy HMO for the first five years and saved Happy HMO .5 million in medical care reduction (Tokarski, 2004).
However, if the goal of a MCO is to reduce their cost and liability it may not be the most cost-effective approach. Smokers incur more health related complications than nonsmokers, however, nonsmokers live longer and can incur more health cost associated with aging (Barendregt, Bonneux, & Van Der Maas, 1997, p. 1052). Taking a closer look at the results from the case study, Happy HMO spends $15.5 million to offer the program for 5 years, and only saves $.5 million in healthcare expenses (Tokarski, 2004). If members of Happy HMO quit smoking, there would be a saving in health care cost in the short-term. Eventually smoking cessation within a population would increase years of life lived and therefore increase healthcare cost to higher rates than current (Barendregt, Bonneux, & Van Der Maas, 1997, p. 1052).
References:
American Heart Association (AHA). (2010a). Smoking Cessation. Retrieved July 22, 2010, from http://www.americanheart.org/presenter.jhtml?identifier=4731
American Heart Association (AHA). (2010b). What are you smoking? Smoking and cardiovascular disease. Retrieved July 21, 2010, http://americanheart.org/downloadable/heart/1244130433852FACTS%20-%20Tobacco%20Fact%20Sheet%2004-23-09%20_FINAL_.pdf
Barendregt, J. J., & Bonneux, L, & Van Der Maas, P. J. (1997). The health care costs of smoking. The New England Journal of Medicine, 1052- 1057.
Centers for Disease Control. (2010). Smoking and tobacco use. Retrieved July 20, 20010, from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/index.htm
Florida Department of Health. (2010). QuitLine. Retrieved July 20, 2010 from http://www.doh.state.fl.us/Tobacco/quitline.html
Gallo, C. (2005). Health matters: promoting health and wellness. Plant the seeds of success for smoking cessation. Nursing CINAHL, 35(9), 68.
Goto, R., Takahashi, Y., Nishimura, S., & Ida, T. (2009). A cohort study to examine whether time and risk preference is related to smoking cessation success. Addiction (Abingdon, England), 104(6), 1018-1024. Retrieved from MEDLINE database.
National Cancer Institute. (2007). Quitting smoking: Why to quit and how to get help. Retrieved July 20, 2010 from www.cancer.gov
Ockene, I. S. & Miller, N. H. (1997). Cigarette smoking, cardiovascular disease, and stroke. American Heart Association, Inc., 96, 3243-3247.
Quit Smoking Support. (1995). What are the benefits of quitting smoking? Retrieved July 20, 2010, from www.quitsmokingsupport.com/benefits
Smokefree.gov (2010). Quit guide. Retrieved July 20, 2010, from http://www.smokefree.gov/quit-guide.aspx
Southard, C. (2007). Smoking cessation initiative: extraordinary success!. Access, 21(5), 8. Retrieved from CINAHL Plus with Full Text database
Tokarski, C. (2004). Smoking cessation treatment cost-effective for health plans. Retrieved July 21, 2010, from Medscape Today Web site: http://www.medscape.com/viewarticle/480313
U.S. Department of Health and Human Services. (1990). The health benefits of smoking cessation: a report of the surgeon general. Center of Disease Control.
Appendix: After working as a team on the Epidemiology paper together, we were able to make a smooth transition into working on this CHD case study together. First, we both individually researched other case studies throughout the book as well as online to come up with some ideas on what we could focus our study on. After going back and forth on several ideas, we both decided that it would be best to focus on one of the modifiable risk factors of CHD. So, we worked on finding research and both came together with our research and collectively decided that the best focus would be on smoking cessation programs and their overall effects for an HMO. Caitlin had come up with very good ideas on questions for the case study, so she was assigned to work on the questions and answers part of our study. Christine had found a good amount of information on the background of smoking and coronary heart disease, so we decided that it would be best for her to work on the beginning of the case study focusing on the background of the paper. Christine was also assigned to post on the Wiki and to keep us focused on our deadlines for this project. We decided to set 4 deadlines to help keep us on track. The first one was set for July 12th, and we were able to come up with several ideas for our case study by this date. The second deadline was set for July 15th, and we narrowed down our choices to one by this date. The 3rd deadline was set for July 24th, which was the date that we were both to have our parts of the study completed. Our last deadline was set for July 25th and we were to have both proofed the paper by this date before the due date of the project on the 26th. To assist us on keeping each other on track, we utilized several communication methods in order to complete this case study project. We had several phone meetings and also utilized email and text messaging to keep each other informed on our progress. In conclusion, we both enjoyed working with each other on both the epidemiology paper and this case study on coronary heart disease. We were able to learn so many new things about CHD in general as well the effects of smoking and CHD, and were truly amazed at the shocking figures. We were able to work well together by realizing each other’s strengths and weaknesses in the early stages. This enabled us to organize, research, write, and assist each other effectively in order to complete both of these projects.
Caitlin Donato and Christine Patton-Mitchell
July 26, 2010
PHC 6000 – Epidemiology
Case Study: Smoking and Coronary Heart Disease
We pledge that we have not plagiarized on any aspect of this assignment.
Executive Summary
Smoking plays a predominant role as one of the risk factors of coronary heart disease. As tobacco use is viewed as both a significant contributing factor but also a modifiable factor, removing this risk factor from the CHD equation is very important to healthcare. Smokers are 2 to 4 times more likely to develop CHD (AHA, 2010b, paras 5 & 7). From a monetary standpoint, smoking is a costly habit as well. A managed care organization can pay as much as 40 percent higher healthcare costs for a smoker than a nonsmoker (Barendregt, Bonneux, & Van Der Maas, 1997, p. 1052).
This case study will take a close look at a smoking cessation program offered by a hypothetical managed care organization called Happy HMO. Outlined below and discussed in detail, this case study will examine the health effectiveness and cost effectiveness for Happy HMO to offer a smoking cessation program.
Health Effectiveness
Smoking programs are successful in getting about ten percent of participants to quit. They are estimated to add 7.1 years of life to every person who quits smoking. For the small percentage of smokers who quit from these programs they are tremendously effective. Once a smoker quits they begin to see immediate health benefits. One benefit of smoking cessation is the reduced risk of coronary heart disease. From the health stand point of Happy HMO; smoking cessation programs are an effective method.
Cost Effectiveness
In terms of lowering Happy HMO’s cost and liability, offering a smoking cessation is not the best option. Cessation programs will cause members to live longer, but along with older age comes age related illnesses. Age related illnesses have proven to be more expensive than smoking related illnesses and will therefore, increase healthcare costs for Happy HMO in the long run.
Overview/Background:
Smoking plays a predominant role as one of the risk factors of coronary heart disease. As tobacco use is viewed as both a significant contributing factor but also a modifiable factor, removing this risk factor from the CHD equation is very important to healthcare.
Tobacco, whether smoked or taken in by breathing secondhand, damages arteries and the heart. It lowers the level of good cholesterol, increases heart rate, and replaces oxygen with carbon monoxide in the blood. Blood clots are more likely to form due to smoking, which can cause heart attacks and strokes (AHA, 2010b, para 1).
Smokers are 2 to 4 times more likely to develop CHD. When looking at those who have CHD, smokers are also 2 to 3 times more likely to die from it than non-smokers. In addition to all of the risks for smokers, it is estimated that annually, 46,000 non-smokers die from coronary heart disease related to exposure to secondhand smoke (AHA, 2010b, paras 5 & 7).
Use:
The CDC reports 2008 cigarette use for adults in the state of Florida at 17.5%. This ranked approximately in the middle, Utah being the lowest at 9.2% and West Virginia (tobacco country) being the highest at 26.6% (CDC, 2010).
2002 data reports specifically for Orange County, Florida, reflect a number higher than the state average with 21% of adults smoking. The age group with the largest number of smokers is 18-44 year olds, which comprised 22.1%. This is also higher than the statewide percentage of 18-44 year olds, which comes in at 15.1%. Teen smoking is also a concern in Orange County where a 2007 study shows 17% of high school students smoked. 60.1% of high school students and 77.2% of middle school students reported they were exposed to secondhand smoke (OCHD, 2010, para 3).
Although tobacco use has decreased over the past ten years with 2007 reports showing a national average of 19.8% of adults smoking, the slow rate of decline makes it highly unlikely that the Healthy People goal of 12% will be met for their 2010 target date once data is finalized (AHA, 2010b, para 8).
Laws and Prevention Programs:
Laws
In addition to the large role it plays in regard to CHD, smoking is also considered to be a factor in numerous other health concerns and therefore the subject of a number of federal, state and local laws. In 2009, the Family Smoking Prevention and Tobacco Control Act was signed into law and authorized the Food and Drug Administration to regulate tobacco products in how they are made, marketed, and sold. Highlights of the law include specific restrictions on teen access and marketing. It requires larger warning labels and requires detailed lists of ingredients (Tobacco Free Kids, 2010).
Prevention Programs
Of the 46 million Americans who smoke cigarettes, many are trying to quit. The American Heart Association estimates that more than 49% of adults who have ever smoked have quit. Each year, approximately 1.3 million smokers are able to quit, many with the help of smoking cessation programs (AHA, 2010a).
There are a number of programs on the national and state levels. Smokefree.gov is an online resource guiding people through preparing to quit, quitting, and staying quit (Smokefree, 2010). In 2006, Florida put into law Amendment 4, which formed the Florida Tobacco Education and Use Prevention Advisory Council. It includes elements such as QuitLine, a toll-free telephone based tobacco cessation service (FDOH, 2010).
The Happy HMO Smoking Cessation Case Study:
The University of Michigan’s School of Public Health pooled together data from three separate managed care organizations to study smoking cessation in a hypothetical MCO, which we will call Happy HMO. The data was used to simulate both the financial impact and the cost effectiveness of tobacco cessation (Tokarski, 2004). Following, we will look at the simulated first five years of the cessation program and explore three key questions that discuss whether or not they are successful in getting people to quit smoking, reduction of CHD, and the overall cost effectiveness for Happy HMO.
Program Overview Chart:
Cessation Program
Questions:
· Are smoking cessation programs successful in getting people to quit smoking?
· Does quitting smoking reduce the risk of coronary heart disease?
· Are smoking cessation programs a cost effective approach for MCOs?
Answers:
Are smoking cessation programs successful in getting people to quit smoking?
Among the members of Happy HMO who participated in the smoking cessation program there was about a 10 percent quit rate, which could be attributed to the smoking cessation program (Tokarski, 2004).
Smoking cessation programs can be successful in causing a small number of people to quit smoking; however, it can often be a result of other factors. For example, it can depend on the smoker’s readiness to quit smoking (Gallo, 2005, p. 1). According to the 1990 Surgeon General Report, smokers who need assistance should have it available (U.S. Department of Health and Human Services, 1990). The smoker who wants to quit and feel that they are ready will have the highest success rate in quitting through a smoking cessation program.
The success rate in smoking cessation programs may appear discouraging; however, more than 90 percent of smokers who attempt to quit smoking without treatment assistance will fail (Southard, 2007, p. 2). Therefore, if a patient is ready to quit smoking then a smoking cessation program is their best option.
There are certain factors within cessation programs that have been proven to yield a higher success rate. One factor is including nicotine replacement or other medication to facilitate cessation. Programs that do not offer nicotine replacements or other medications increase the cessation rate by about six percent over programs that do offer nicotine replacements (Fleming, 2008, p. 359). Another aspect that can increase the successfulness of a program is to have health professional’s recommend the program (Southard, 2007, p. 3).
Does quitting smoking reduce the risk of coronary heart disease?
Smoking cessation has been proven to allow people to live a longer life than continual smokers (U.S. Department of Health and Human Services, 1999, p.1). A smoker’s body will begin a series of changes within minutes of smoking cessation. It only takes 20 minutes after the last cigarette for the smoker’s blood pressure to drop to normal. After just 24 hours of smoking cessation the chances that person will suffer a heart attack already decreases. The person can decrease their excess risk of coronary heart disease to half that of a smoker after one year of quitting (Quit Smoking Support, 1995, para. 2).
Numerous studies have shown a substantial decrease in CHD deaths for former smokers compared to smokers who never quit. Not only will smoking cessation reduce the risk of developing coronary heart disease, but it will also reduce the risk of reoccurring illnesses by as much as fifty percent (Ockene & Miller, 1997, pp.3243-3247). People who quit smoking are less likely to die from smoking related illnesses, regardless of their age (National Cancer Institute, 2007).
Are smoking cessation programs a cost-effective approach for a managed care organization?
If the goal of Happy HMO is to reduce the amount of enrollee’s that smoke, then offering a cessation program is a cost-effective approach. Covering smoking cessation programs have been found to add 7.1 years to a MCO enrollee’s life expectancy. The cost of cessation programs compared to a health plan’s total expenditures is minimal.
There were 54,488 enrollees of Happy HMO that used the covered smoking cessation program in the first five years. As a result 4,892 members quit than would have without coverage. The smoking cessation program resulted in $0.63 per member per month expenditures to Happy HMO for the first five years and saved Happy HMO .5 million in medical care reduction (Tokarski, 2004).
However, if the goal of a MCO is to reduce their cost and liability it may not be the most cost-effective approach. Smokers incur more health related complications than nonsmokers, however, nonsmokers live longer and can incur more health cost associated with aging (Barendregt, Bonneux, & Van Der Maas, 1997, p. 1052). Taking a closer look at the results from the case study, Happy HMO spends $15.5 million to offer the program for 5 years, and only saves $.5 million in healthcare expenses (Tokarski, 2004). If members of Happy HMO quit smoking, there would be a saving in health care cost in the short-term. Eventually smoking cessation within a population would increase years of life lived and therefore increase healthcare cost to higher rates than current (Barendregt, Bonneux, & Van Der Maas, 1997, p. 1052).
References:
American Heart Association (AHA). (2010a). Smoking Cessation. Retrieved July 22, 2010, from http://www.americanheart.org/presenter.jhtml?identifier=4731
American Heart Association (AHA). (2010b). What are you smoking? Smoking and cardiovascular disease. Retrieved July 21, 2010,
http://americanheart.org/downloadable/heart/1244130433852FACTS%20-%20Tobacco%20Fact%20Sheet%2004-23-09%20_FINAL_.pdf
Barendregt, J. J., & Bonneux, L, & Van Der Maas, P. J. (1997). The health care costs of smoking. The New England Journal of Medicine, 1052- 1057.
Centers for Disease Control. (2010). Smoking and tobacco use. Retrieved July 20, 20010, from
http://www.cdc.gov/tobacco/data_statistics/fact_sheets/index.htm
Florida Department of Health. (2010). QuitLine. Retrieved July 20, 2010 from
http://www.doh.state.fl.us/Tobacco/quitline.html
Gallo, C. (2005). Health matters: promoting health and wellness. Plant the seeds of success for smoking cessation. Nursing CINAHL, 35(9), 68.
Goto, R., Takahashi, Y., Nishimura, S., & Ida, T. (2009). A cohort study to examine whether time and risk preference is related to smoking cessation success. Addiction (Abingdon, England), 104(6), 1018-1024. Retrieved from MEDLINE database.
National Cancer Institute. (2007). Quitting smoking: Why to quit and how to get help. Retrieved July 20, 2010 from www.cancer.gov
Ockene, I. S. & Miller, N. H. (1997). Cigarette smoking, cardiovascular disease, and stroke. American Heart Association, Inc., 96, 3243-3247.
Quit Smoking Support. (1995). What are the benefits of quitting smoking? Retrieved July 20, 2010, from www.quitsmokingsupport.com/benefits
Smokefree.gov (2010). Quit guide. Retrieved July 20, 2010, from http://www.smokefree.gov/quit-guide.aspx
Southard, C. (2007). Smoking cessation initiative: extraordinary success!. Access, 21(5), 8. Retrieved from CINAHL Plus with Full Text database
Tokarski, C. (2004). Smoking cessation treatment cost-effective for health plans. Retrieved July 21, 2010, from Medscape Today Web site: http://www.medscape.com/viewarticle/480313
U.S. Department of Health and Human Services. (1990). The health benefits of smoking cessation: a report of the surgeon general. Center of Disease Control.
Appendix:
After working as a team on the Epidemiology paper together, we were able to make a smooth transition into working on this CHD case study together. First, we both individually researched other case studies throughout the book as well as online to come up with some ideas on what we could focus our study on. After going back and forth on several ideas, we both decided that it would be best to focus on one of the modifiable risk factors of CHD. So, we worked on finding research and both came together with our research and collectively decided that the best focus would be on smoking cessation programs and their overall effects for an HMO.
Caitlin had come up with very good ideas on questions for the case study, so she was assigned to work on the questions and answers part of our study. Christine had found a good amount of information on the background of smoking and coronary heart disease, so we decided that it would be best for her to work on the beginning of the case study focusing on the background of the paper. Christine was also assigned to post on the Wiki and to keep us focused on our deadlines for this project.
We decided to set 4 deadlines to help keep us on track. The first one was set for July 12th, and we were able to come up with several ideas for our case study by this date. The second deadline was set for July 15th, and we narrowed down our choices to one by this date. The 3rd deadline was set for July 24th, which was the date that we were both to have our parts of the study completed. Our last deadline was set for July 25th and we were to have both proofed the paper by this date before the due date of the project on the 26th.
To assist us on keeping each other on track, we utilized several communication methods in order to complete this case study project. We had several phone meetings and also utilized email and text messaging to keep each other informed on our progress.
In conclusion, we both enjoyed working with each other on both the epidemiology paper and this case study on coronary heart disease. We were able to learn so many new things about CHD in general as well the effects of smoking and CHD, and were truly amazed at the shocking figures. We were able to work well together by realizing each other’s strengths and weaknesses in the early stages. This enabled us to organize, research, write, and assist each other effectively in order to complete both of these projects.