To the Editor. —
Bennett et al1 of The RAND Corporation examined hospitalizations for acquired immunodeficiency syndrome (AIDS)—related Pneumocystis carinii pneumonia (PCP) at 15 California hospitals and found lower mortality rates at the hospitals with "high AIDS familiarity." However, because of methodological problems that cast doubt on this finding, policymakers should be cautious about the authors' recommendations, particularly with regard to the regionalization of acute care for AIDS.The sample of hospitals used for this study may not have been suitable for a comparison between high and low levels of AIDS familiarity, because none of the hospitals in California with the highest AIDS familiarity were included. In particular, none of the five most experienced hospitals in San Francisco, which provided 80% of that city's acute AIDS care in 1986, were among the study hospitals.2 We base this conclusion on the human immunodeficiency virus—related volume statistics presented by the
Green J, Leigh MR, Passman LJ. AIDS Treatment Center: Is the Concept Premature? JAMA. 1989;262(18):2537. doi:10.1001/jama.1989.03430180075014
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