Variations in intensive care unit utilization for patients with human immunodeficiency virus-related Pneumocystis carinii pneumonia: importance of hospital characteristics and geographic location Export

@article{Curtis1998, abstract = {OBJECTIVE: To determine whether intensive care unit (ICU) use and outcomes for patients with human immunodeficiency virus (HIV)-related Pneumocystis carinii pneumonia vary by hospital characteristics and geographic location. DESIGN: Retrospective review of the medical records of 2,174 patients with HIV-related P. carinii pneumonia. SETTING: Random sample of 73 private, nine public, and 14 Veterans Affairs hospitals in five cities (Chicago, New York, Los Angeles, Miami, and Durham, NC). PATIENTS: Stratified random sample of patients hospitalized with HIV-related P. carinii pneumonia from 1987 to 1990. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 2,174 patients with P. carinii pneumonia, 398 (18\%) patients received care in an ICU. ICU utilization varied significantly by patient and hospital characteristics, as well by as geographic location. Non-Hispanic whites, patients with Medicaid, and patients with a prior acquired immunodeficiency syndrome-defining illness were the least likely to receive care in an ICU. Patients in county- or state-owned hospitals and patients in hospitals with more P. carinii pneumonia-experience were also less likely to be cared for in an ICU. These differences in ICU utilization persisted when controlling for severity of illness, as well as other patient characteristics. Significant geographic variation in ICU utilization persisted after controlling for patient and hospital characteristics. Survival to hospital discharge after an ICU stay was significantly higher for patients without a prior acquired immunodeficiency syndrome-defining illness and for patients in hospitals with more P. carinii pneumonia experience. CONCLUSIONS: We found significant variations in ICU utilization by hospital characteristics and geographic location that remained significant after controlling for severity of illness and patient sociodemographic characteristics. Hospital and geographic variations in ICU utilization may make it difficult to generalize ICU outcomes across different hospitals.}, author = {Curtis, J. R. and Bennett, C. L. and Horner, R. D. and Rubenfeld, G. D. and Dehovitz, J. A. and Weinstein, R. A.}, citeulike-article-id = {1129943}, journal = {Crit Care Med}, keywords = {adult, aids-related, allocation, analysis, atlas, care, comparative, ethnic, female, govt, groups, health, hospital, hospitalsclassification, humans, illness, index, infectionsmortality, insurance, intensive, male, mortality, non-phs, non-us, of, opportunistic, phs, pneumocystismortality, pneumonia, random, regression, research, retrospective, severity, states, studies, study, support, therapy, united, units, us, utilization}, month = {Apr}, number = {4}, pages = {668--75}, posted-at = {2007-02-28 15:54:11}, priority = {2}, title = {Variations in intensive care unit utilization for patients with human immunodeficiency virus-related Pneumocystis carinii pneumonia: importance of hospital characteristics and geographic location}, volume = {26}, year = {1998} }

TY - JOUR ID - Curtis1998 L3 - citeulike-article-id:1129943 N2 - OBJECTIVE: To determine whether intensive care unit (ICU) use and outcomes for patients with human immunodeficiency virus (HIV)-related Pneumocystis carinii pneumonia vary by hospital characteristics and geographic location. DESIGN: Retrospective review of the medical records of 2,174 patients with HIV-related P. carinii pneumonia. SETTING: Random sample of 73 private, nine public, and 14 Veterans Affairs hospitals in five cities (Chicago, New York, Los Angeles, Miami, and Durham, NC). PATIENTS: Stratified random sample of patients hospitalized with HIV-related P. carinii pneumonia from 1987 to 1990. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 2,174 patients with P. carinii pneumonia, 398 (18%) patients received care in an ICU. ICU utilization varied significantly by patient and hospital characteristics, as well by as geographic location. Non-Hispanic whites, patients with Medicaid, and patients with a prior acquired immunodeficiency syndrome-defining illness were the least likely to receive care in an ICU. Patients in county- or state-owned hospitals and patients in hospitals with more P. carinii pneumonia-experience were also less likely to be cared for in an ICU. These differences in ICU utilization persisted when controlling for severity of illness, as well as other patient characteristics. Significant geographic variation in ICU utilization persisted after controlling for patient and hospital characteristics. Survival to hospital discharge after an ICU stay was significantly higher for patients without a prior acquired immunodeficiency syndrome-defining illness and for patients in hospitals with more P. carinii pneumonia experience. CONCLUSIONS: We found significant variations in ICU utilization by hospital characteristics and geographic location that remained significant after controlling for severity of illness and patient sociodemographic characteristics. Hospital and geographic variations in ICU utilization may make it difficult to generalize ICU outcomes across different hospitals. IS - 4 JF - Crit Care Med EP - 75 TI - Variations in intensive care unit utilization for patients with human immunodeficiency virus-related Pneumocystis carinii pneumonia: importance of hospital characteristics and geographic location VL - 26 SP - 668 KW - adult KW - aids-related KW - allocation KW - analysis KW - atlas KW - care KW - comparative KW - ethnic KW - female KW - govt KW - groups KW - health KW - hospital KW - hospitalsclassification KW - humans KW - illness KW - index KW - infectionsmortality KW - insurance KW - intensive KW - male KW - mortality KW - non-phs KW - non-us KW - of KW - opportunistic KW - phs KW - pneumocystismortality KW - pneumonia KW - random KW - regression KW - research KW - retrospective KW - severity KW - states KW - studies KW - study KW - support KW - therapy KW - united KW - units KW - us KW - utilization AU - Curtis, JR AU - Bennett, CL AU - Horner, RD AU - Rubenfeld, GD AU - Dehovitz, JA AU - Weinstein, RA PY - 1998/Apr// ER -