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July 1990

The Relation Between Resource Use and In-hospital Mortality for Patients With Acquired Immunodeficiency Syndrome–Related Pneumocystis carinii Pneumonia

Author Affiliations

From the Departments of Social Sciences (Dr Bennett), Economics and Statistics (Dr Gertler and Mr Garfinkle), and Behavioral Sciences (Dr Kanouse), The RAND Corporation, Santa Monica, Calif; Department of Medicine, University of California at Los Angeles School of Medicine and the West Los Angeles Veterans Administration Hospital (Drs Bennett and Guze); the Department of Medicine, Tufts University and the New England Medical Center, Boston, Mass (Dr Greenfield).

Arch Intern Med. 1990;150(7):1447-1452. doi:10.1001/archinte.1990.00390190099015

• A central issue in health policy with regard to the acquired immunodeficiency syndrome (AIDS) is whether quality of care and patient outcomes are affected by resource constraints. In an earlier study of 15 California hospitals between October 1986 and October 1987, we observed a markedly lower in-hospital mortality rate for Pneumocystis carinii pneumonia in the group of patients treated in hospitals that had a high level of experience with AIDS relative to the group treated in hospitals with low experience. We present the patterns of resource use at hospitals with high and low AIDS familiarity. Average charges and resource use did not differ between the two groups of hospitalized patients; however, there were marked variations in how the resources were used. Among survivors, patients who received care at hospitals with high AIDS familiarity stayed in the hospital longer, underwent a bronchoscopy more often, stayed in an intensive care unit longer, and accrued higher average total charges than patients at hospitals with low AIDS familiarity. Conversely, among nonsurvivors, a greater intensity of care was received at the hospitals with low AIDS familiarity. These results suggest that, in these 15 hospitals, the markedly higher rate of in-hospital death at hospitals with low AIDS familiarity was not related to the quantity of resources that were used; rather it was related to differences in how the resources were used. Our results show that additional resources significantly improved the chances of in-hospital survival for patients at hospitals with high AIDS familiarity, but did not affect the chances of survival in hospitals with low AIDS familiarity. Our findings suggest that physicians in those hospitals in which the care of patients with AIDS is relatively infrequent might improve the chances of in-hospital survival of patients with AIDS by more timely and efficient use of resources.

(Arch Intern Med. 1990;150:1447-1452)