title: HIV patients' experiences with inpatient and outpatient care: results of a national survey.
abstract: BACKGROUND
  Little is known about HIV patients' care experiences.
  
  
  OBJECTIVE
  To assess HIV patients' experiences with inpatient and outpatient care, and to assess the relationship and relative influence of patient characteristics and site of care on care experiences.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Patients with HIV receiving care outside of emergency rooms, prisons, or the military throughout the continental United States. One thousand seventy-four patients provided ratings of an inpatient stay and 2204 rated an outpatient visit; 818 patients provided evaluations of both inpatient and outpatient care.
  
  
  METHODS
  A national probability sample of persons in care for HIV from the HIV Cost and Services Utilization Study.
  
  
  METHODS
  Outcome variables were rates of problems with, and global ratings of, inpatient and outpatient care.
  
  
  RESULTS
  Mean problem rates were 20.9% and 8.4% (lower score means fewer problems) for inpatient and outpatient care, respectively. On 9 of 10 of the individual inpatient report items, 15% or more of respondents reported problems. Global ratings of inpatient and outpatient care were 65.3 and 75.0 (0-100 scale, higher scores indicate better ratings), respectively. In multivariable models that controlled for site effects, the only patient characteristic that was consistently associated with problem rates and global ratings of care was mental health (P <0.0001 for both inpatient and outpatient care). Models including site effects explained two to four times as much variance as models excluding site effects.
  
  
  CONCLUSIONS
  Inpatients with HIV reported higher problem rates with inpatient than outpatient care. Better provider-patient communication during inpatient stays is needed. For both inpatient and outpatient care, quality improvement efforts may be most productively focused on providers and processes of care at sites rather than on specific patient subgroups.
authors.affiliation: Division of Clinical Care Research, Department of Medicine, Tufts New England Medical Center #345, 750 Washington Street, Boston, MA 02111, USA. IWilson@Lifespan.org
authors.forename: Ira B
authors.initials: IB
authors.lastname: Wilson
authors.forename: Lin
authors.initials: L
authors.lastname: Ding
authors.forename: Ron D
authors.initials: RD
authors.lastname: Hays
authors.forename: Martin F
authors.initials: MF
authors.lastname: Shapiro
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Bozzette
authors.forename: Paul D
authors.initials: PD
authors.lastname: Cleary
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000592:standards; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D015658:HIV Infections / Q000628:therapy*; D006801:Humans; D007297:Inpatients; D007407:Interviews as Topic; D008875:Middle Aged; D017060:Patient Satisfaction; D011336:Probability; D012494:Sampling Studies; D014481:United States