Document 1807
 DOCN  M94A1807
 TI    Impact of hospital experience on HIV-disease mortality.
 DT    9412
 AU    Le R; Hogg RS; Thomson A; Strathdee SA; Schechter MT; O'Shaughnessy MV;
       Montaner JS; British Columbia (BC) Centre for Excellence in HIV/AIDS,;
       Vancouver, Canada.
 SO    Int Conf AIDS. 1994 Aug 7-12;10(1):447 (abstract no. PD0397). Unique
       Identifier : AIDSLINE ICA10/94370768
 AB    OBJECTIVE: To assess the relationship between HIV/AIDS caseload and
       HIV-disease mortality in hospitals. METHODS: A population-based study
       was conducted using cases in the HMRI data system (Hospital Programs,
       B.C. Ministry of Health) from 1987-92, which had HIV/AIDS diagnostic
       codes (ICD-9-CM 042-044 and 795.8) on their discharge abstract. High
       (HEH) experienced hospitals were defined a priori as the 5 tertiary
       hospitals with the highest absolute number of HIV/AIDS admissions. Low
       experienced hospitals (LEH; n = 56) were all remaining hospitals which
       had HIV admissions. Logistic regression determined which of gender, age,
       admission type & year, ICU use, AIDS, case mix group, and resource
       intensity weight, predicted hospital experience and total & PCP
       mortality. RESULTS: A total of 4250 cases (3584 in HEH; 666 in LEH) were
       identified. Overall mortality rates increased in HEH from 83 per 1000 in
       87/88 to 184 per 1000 in 1991/92 and remained steady in LEH at 128 per
       1000 over the same interval (see figure). From 87-92, PCP mortality
       rates rose in both groups from 90.4 to 175 per 1000 in HEH and 138 to
       229 per 1000 in LEH. Overall mortality was associated patients who had
       AIDS (p = 0.001), spent time in ICU (p = 0.0001), were more recently
       admitted (p = 0.0001), were older (p = 0.0001), received acute level
       care (p = 0.0001), or were admitted to HEH (p = 0.0473). PCP mortality
       was associated with cases from patients who spent time in ICU (p =
       0.0001), were older (p = 0.0001), and received acute level care. HEH
       cases were more likely to be males (p = 0.0001), have longer lengths of
       stay (p = 0.0001), have AIDS (p = 0.0001), and AIDS-related case mix
       group (p = 0.0005). CONCLUSIONS: Unlike other studies, this analysis
       demonstrates that high experienced hospitals in the province do not
       consistently have lower mortality rates. This is likely due to the fact
       that HEH cases were more often AIDS or from an AIDS-related case mix
       group. We attribute the increasing mortality in the high experience
       hospitals to a shift in admission patterns towards sicker patients and
       terminal care. TABULAR DATA, SEE ABSTRACT VOLUME.
 DE    AIDS-Related Opportunistic Infections/MORTALITY  British Columbia
       Female  *Hospital Mortality  Human  HIV Infections/*MORTALITY  Male
       Pneumonia, Pneumocystis carinii/MORTALITY  MEETING ABSTRACT

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