GEOGRAPHIC-VARIATION IN THE MANAGEMENT AND OUTCOME OF PATIENTS WITH AIDS-RELATED PNEUMOCYSTIS-CARINII PNEUMONIA

Pneumocystis carinii pneumonia (PCP) is one of the most common reasons for the hospitalization of AIDS patients; however, geographic differe nces in PCP management have not been evaluated previously. Therefore, we abstracted data on socioeconomic characteristics, prior HIV care, s everity of illness, timeliness and intensity of in-hospital care, dura tion of hospitalization, and survival from 1547 randomly selected medi cal records of patients hospitalized with AIDS-related PCP between 198 7 and 1990 at 82 hospitals in Chicago, Los Angeles, Miami, New York Ci ty, and Raleigh-Durham, North Carolina. Multivariate regression models were used tea assess factors associated with longer hospital stays an d increased inpatient mortality. Our results showed that in-hospital m ortality ranged from 15% to 27%, bronchoscopy rates from 53% to 70%, a nd mean length of stay from 14 days to 23 days. Geographic variations in mortality were accounted for by differences in severity of illness at admission, insurance status, and in-hospital patient management. Ho wever, significant regional variations in hospital length of stay pers isted, even after adjusting for patient demographics, severity of illn ess, and use of diagnostic and therapeutic care resources.