US HOSPITAL-CARE FOR HIV-INFECTED PERSONS AND THE ROLE OF PUBLIC, PRIVATE, AND VETERANS-ADMINISTRATION HOSPITALS

Hospitals are a major provider of medical care for human immunodeficie ncy virus (HIV)-infected persons. Although utilization and patterns of care profiles in public and private hospitals have been evaluated for acquired immunodeficiency syndrome (AIDS)-related Pneumocystis carini i pneumonia (PCP), one of the most costly and common severe complicati ons of AIDS, information from Veterans Administration (VA) hospitals h as not been reported previously. This article reports on inpatient car e for PCP patients by obtaining data from VA, private, and public hosp itals. Cost and resource utilization data were obtained from reviews o f medical records, claims, and provider bills from 26 non-VA hospitals and 18 VA hospitals in IO cities in the United States. Data on severi ty of illness, patterns of care, and outcomes for PCP were obtained fr om medical record reviews from 2, 174 PCP cases treated in 82 non-VA a nd 14 VA hospitals in five U.S. cities. Estimates were made of the ave rage costs and the rates of use of diagnostic tests, anti-PCP medicati ons, and intensive care units for samples of public hospital, private hospital, and VA patients with PCP. With mean charges for a single PCP episode of $14,500 to $16,060, PCP remains one of the most costly com plications of AIDS. Although the severity of PCP illness at admission was greatest at public hospitals, the intensity of care was lowest: fo r frequency of cytologic diagnosis (48% at public, 62% at VA, and 66% at private hospitals, bronchoscopy (45% at public, 60% at VA, and 66% at private hospitals), and intensive care unit use (11% at public, 22% at VA, and 19% at private hospitals). in-hospital mortality rates for PCP also differed in the three types of hospitals (20% at public, 24% at VA, and 18% at private hospitals). Patterns of PCP care differ amo ng VA, public, and private hospitals. Future studies on the HIV epidem ic should include data collected from uniform data sources from VA hos pitals, in addition to public and private hospitals, to provide insigh t on the processes of carl and outcomes for HIV-infected persons.