US hospital care for patients with HIV infection and pneumonia: the role of public, private, and Veterans Affairs hospitals in the early highly active antiretroviral therapy era.
OBJECTIVE
We evaluated differences in processes and outcomes of HIV-related pneumonia care among patients in Veterans Affairs (VA), public, and for-profit and not-for-profit private hospitals in the United States. We compared the results of our current study (1995 to 1997) with those of our previous study that included a sample of patients receiving care during the years 1987 to 1990 to determine how HIV-related pneumonia care had evolved over the last decade.


METHODS
The sample consisted of 1,231 patients with HIV infection who received care for Pneumocystis carinii pneumonia (PCP) and 750 patients with HIV infection who received care for community-acquired pneumonia (CAP) during the years 1995 to 1997.


METHODS
We conducted a retrospective medical record review and evaluated patient and hospital characteristics, HIV-related processes of care (timely use of anti-PCP medications, adjunctive corticosteroids), non-HIV-related processes of care (timely use of CAP treatment medications, diagnostic testing, ICU utilization, rates of endotracheal ventilation, placement on respiratory isolation), length of inpatient hospital stay, and inpatient mortality.


RESULTS
Rates of timely use of antibiotics and adjunctive corticosteroids for treating PCP were high and improved dramatically from the prior decade. However, compliance with consensus guidelines that recommend < 8 h as the optimal time window for initiation of antibiotics to treat CAP was lower. For both PCP and CAP, variations in processes of care and lengths of in-hospital stays, but not mortality rates, were noted at VA, public, private not-for-profit hospitals, and for-profit hospitals.


CONCLUSIONS
This study provides the first overview of HIV-related pneumonia care in the early highly active antiretroviral therapy era, and contrasts current findings with those of a similarly conducted study from a decade earlier. Quality of care for patients with PCP improved, but further efforts are needed to facilitate the appropriate management of CAP. In the third decade of the epidemic, it will be important to monitor whether variations in processes of care for various HIV-related clinical diagnoses among different types of hospitals persist.
Uphold
Constance R
CR
Rehabilitation Outcomes Research Center, North Florida/South Georgia Veterans Health System, Research Department, Stop 151, 1601 SW Archer Road, Gainesville, FL 32608-1197, USA. Connie.Uphold@med.va.gov
Deloria-Knoll
Maria
M
Palella
Frank J
FJ
Parada
Jorge P
JP
Chmiel
Joan S
JS
Phan
Laura
L
Bennett
Charles L
CL
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D019538:Health Care Surveys; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000706:statistics & numerical data*; D016304:Hospitals, Private / Q000592:standards / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000592:standards / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D011336:Probability; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs