The relation between resource use and in-hospital mortality for patients with acquired immunodeficiency syndrome-related Pneumocystis carinii pneumonia

Article Abstract:

The relation between use of resources, quality of care, and outcome of AIDS patients was assessed in 15 California hospitals between October 1986 and October 1987. Hospitals with more familiarity or experience in caring for AIDS patients had lower death rates due to Pneumocystis carinii pneumonia, a common complication of AIDS, as compared to hospitals with less experience. The use of resources for treating AIDS patients was evaluated in hospitals with high and low AIDS familiarity. Although the average charges and resource use did not differ between the two groups of hospitalized patients, the ways in which resources were used varied. Surviving AIDS patients who were cared for at hospitals with high AIDS familiarity had longer hospital stays, spent more time in intensive care units, had more frequent examinations by bronchoscopy (a procedure for inspecting the airways), and accrued higher charges than patients cared for at hospitals with low AIDS familiarity. These results suggest that the higher rate of in-hospital death at hospitals with low AIDS familiarity was related to differences in how resources were used rather than quantity of resources used. The addition of resources improved the survival rate in hospitals with high AIDS familiarity but not in hospitals with low AIDS familiarity. The survival of AIDS patients in hospitals with low AIDS familiarity may be improved by more efficient and timely use of resources. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Usage, Medical care, AIDS patients

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The relation between hospital experience and in-hospital mortality for patients with AIDS-related PCP

Article Abstract:

The establishment of regional hospital centers specifically designed to treat patients with acquired immunodeficiency syndrome (AIDS) is a topic of debate among physicians and federal and local governments. The mortality rate of AIDS patients whose illnesses were complicated by AIDS-related Pneumocystis carinii pneumonia (PCP) was evaluated in hospitals with considerable experience in treating AIDS patients and in hospitals without as much experience. The study found that 15.2 percent of AIDS patients also suffering from AIDS-related PCP died while in the hospital. Hospitals with greater experience in treating AIDS patients provided better care and had a significantly lower in-hospital mortality rate for AIDS patients than less experienced hospitals (12 percent versus 33 percent, respectively). Three options should be considered by policymakers: the creation of regional AIDS centers, which would specialize in treating AIDS patients; the implementation of policies that would increase the experience of hospitals which see few AIDS-infected patients; or the establishment of highly focused medical education efforts aimed at facilities with little experience in treating patients with the Human Immunodeficiency Virus (HIV), the virus that causes AIDS.

Complications and side effects, Hospital patients, Health risk assessment, AIDS (Disease)

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Variations in resource utilization among medical specialties and systems of care: results from the Medical Outcomes Study

Article Abstract:

Treatment by specialists in solo or small single-speciality practices may be more expensive than treatment by general practitioners in health maintenance organizations. A survey of approximately 20,000 adult patients who visited a physician's office within different nine day periods, found that treatment by cardiologists and endocrinologists was more expensive than treatment by family practitioners and general internists. Patients treated by cardiologists and endocrinologists had more hospitalizations, tests and procedures, and took more prescription drugs than those treated by family practitioners and general internists. Patients treated by family practitioners tended to be younger and healthier with fewer chronic medical conditions than those treated by general internists, cardiologists and endocrinologists. Patients treated by solo or small single-speciality practices were hospitalized 41% more often than those treated by health maintenance organizations.

Medicine, Economic aspects, Practice, Health maintenance organizations, Medical practice, Group medical practice, Medical specialties

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