title: Is inadequate human immunodeficiency virus care associated with increased ED and hospital utilization? A prospective study in human immunodeficiency virus-positive ED patients.
abstract: BACKGROUND
  There is a lack of data on the effect(s) of suboptimal human immunodeficiency virus (HIV) care on subsequent health care utilization among emergency department (ED) patients with HIV. Findings on their ED and inpatient care utilization patterns will provide information on service provision for those who have suboptimal access to HIV-related care.
  
  
  METHODS
  A pilot prospective study was conducted on HIV-positive patients in an ED. At enrollment, participants were interviewed regarding health care utilization. Participants were followed up for 1 year, during which time data on ED visits and hospitalizations were obtained from their patient records. Inadequate HIV care (IHC) was defined according to Infectious Diseases Society of America recommendations as less than 3 scheduled clinic visits for HIV care in the year before enrollment. Cox regression models were used to evaluate whether IHC was associated with increased hazard of health care utilization.
  
  
  RESULTS
  Of 107 subjects, 36% were found to have IHC. Inadequate HIV care did not predict more frequent ED visits but was significantly associated with fewer hospitalizations (adjusted incidence rate ratio, 0.61 [95% CI: 0.43-0.86]). Inadequate HIV care did not significantly increase the hazard for earlier ED visit or hospitalization. However, further stratification analysis found that IHC increased the hazard of hospitalization for subjects without comorbid diseases (adjusted hazard ratio, 2.50 [95% CI: 1.10-5.68]).
  
  
  CONCLUSIONS
  In our setting, IHC does not appear to be associated with earlier or more frequent ED visits but may lead to earlier hospitalization, particularly among those without other chronic diseases.
authors.affiliation: Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21209, USA.
authors.forename: T Rinda
authors.initials: TR
authors.lastname: Soong
authors.forename: Julianna J
authors.initials: JJ
authors.lastname: Jung
authors.forename: Gabor D
authors.initials: GD
authors.lastname: Kelen
authors.forename: Richard E
authors.initials: RE
authors.lastname: Rothman
authors.forename: Avanthi
authors.initials: A
authors.lastname: Burah
authors.forename: Judy B
authors.initials: JB
authors.lastname: Shahan
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Hsieh
mesh_terms: D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011787:Quality of Health Care / Q000706:statistics & numerical data