Organization and outcomes of inpatient AIDS care.
OBJECTIVE
To compare differences in AIDS patients' 30-day mortality and satisfaction with care in dedicated AIDS units, scattered-bed units in hospitals with and without dedicated AIDS units, and in magnet hospitals known to provide good nursing care.


METHODS
Data were obtained on 1,205 consecutively admitted patients in 40 units in 20 hospitals and on 820 of their nurses.


RESULTS
Mortality was lower and satisfaction was higher for AIDS patients in dedicated AIDS units and in nursing magnet hospitals. Primary nursing, end-of-life care counseling, and discharge planning were also more common. Higher nurse to patient ratios and AIDS physician specialty services were strongly associated with lower mortality. Patient satisfaction was strongly associated with organizational control of care by bedside nurses. Homosexuals were more likely to be admitted to dedicated AIDS units, which largely explains the under-representation of minorities and women.


CONCLUSIONS
Dedicated AIDS units and magnet hospitals offer important benefits to AIDS patients, including lower odds on dying within 30 days of admission, higher patient satisfaction, and care meeting professional standards. Better nurse staffing, AIDS physician specialty services, and more organizational control by bedside nurses improve patient outcomes.
Aiken
L H
LH
Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia 19104-6096, USA. laiken@pop.upenn.edu
Sloane
D M
DM
Lake
E T
ET
Sochalski
J
J
Weber
A L
AL
D000163:Acquired Immunodeficiency Syndrome / Q000401:mortality / Q000628:therapy*; D000328:Adult; D019985:Benchmarking; D005260:Female; D017052:Hospital Mortality; D006757:Hospital Units / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000379:methods / Q000458:organization & administration* / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States / Q000453:epidemiology