TREATMENT ADEQUACY FOR HIV-RELATED PNEUMOCYSTIS PNEUMONIA - QUALITY MEASURES FOR INPATIENT CARE

To develop and evaluate severity-adjusted indicators of treatment time liness and adequacy for inpatient care of first episode of HIV-related pneumocystis pneumonia, a retrospective cohort study (n=414) using me dical record review was conducted in six California medical centers (1 January 1983-30 June 1987), Measures included patient baseline charac teristics and complexity, process-of-care indicators (delay in treatme nt initiation and proportion of adequate treatment delivered), and ove rall survival of hospitalization and survival without respiratory fail ure, Logistic regression models of severity were developed among optim ally treated patients and cross-validated. Exposure to medication with pneumocystis activity within 30 days prior to admission was protectiv e, After controlling for pre-admission medication and severity, the av erage proportion of adequate pneumocystis medication delivered during the first 7 and 30 days were significant predictors of outcome in all models. Delay in treatment initiation, while not a statistically signi ficant predictor, was associated with baseline severity, Summary measu res of treatment adequacy show promise as process-of-care indicators. (C) 1997 Elsevier Science Ltd.