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

Constance R. Uphold, Maria Deloria Knoll, Frank J. Palella, Jorge P. Parada, Joan S. Chmiel, Laura Phan, Charles L. Bennett

Research output: Contribution to journalArticle

Abstract

Study objectives: 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. Setting/patients: 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. Measurement: 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.

Original languageEnglish (US)
Pages (from-to)548-556
Number of pages9
JournalChest
Volume125
Issue number2
DOIs
StatePublished - Feb 2004
Externally publishedYes

Fingerprint

Veterans Hospitals
Highly Active Antiretroviral Therapy
Secondary Prevention
HIV Infections
Pneumonia
Patient Care
Pneumocystis Pneumonia
HIV
Proprietary Hospitals
Voluntary Hospitals
Veterans
Inpatients
Length of Stay
Adrenal Cortex Hormones
Anti-Bacterial Agents
Mortality
Quality of Health Care
Medical Records
Ventilation
Guidelines

Keywords

  • Community-acquired pneumonia
  • HIV
  • Pneumocystis cariini pneumonia
  • Quality of care

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

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. / Uphold, Constance R.; Knoll, Maria Deloria; Palella, Frank J.; Parada, Jorge P.; Chmiel, Joan S.; Phan, Laura; Bennett, Charles L.

In: Chest, Vol. 125, No. 2, 02.2004, p. 548-556.

Research output: Contribution to journalArticle

Uphold, Constance R. ; Knoll, Maria Deloria ; Palella, Frank J. ; Parada, Jorge P. ; Chmiel, Joan S. ; Phan, Laura ; Bennett, Charles L. / 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. In: Chest. 2004 ; Vol. 125, No. 2. pp. 548-556.
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