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M94A1807.TXT
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1994-10-24
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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
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).