VARIATIONS IN INTENSIVE-CARE UNIT UTILIZATION FOR PATIENTS WITH HUMANIMMUNODEFICIENCY VIRUS-RELATED PNEUMOCYSTIS-CARINII PNEUMONIA - IMPORTANCE OF HOSPITAL CHARACTERISTICS AND GEOGRAPHIC LOCATION

Objective: To determine whether intensive care unit ([CU) use and outc omes for patients with human immunodeficiency virus (HIV)-related Pneu mocystis carinii pneumonia vary by hospital characteristics and geogra phic location. Design: Retrospective review of the medical records of 2,174 patients with HIV-relaled P, carinii pneumonia. Setting: Random sample of 73 private, nine public, and 14 Veterans Affairs hospitals i n five cities (Chicago, New York, Los Angeles, Miami, and Durham, Nc). Patients: Stratified random sample of patients hospitalized with HIV-r elated P. carinii pneumonia from 1987 to 1990. Interventions: None. Me asurements 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 whiles, patients with Medicai d, and patients with a prior acquired immunodeficiency syndrome defini ng illness were the least likely to receive care in an ICU. Patients i n county-or stale-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 control ling 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 hosp ital discharge after an ICU stay was significantly higher for patients with out a prior acquired immunodeficiency syndrome-defining illness and for patients in hospitals with more P. carinii pneumonia experienc e. Conclusions: We found significant variations in ICU utilization by hospital characteristics and geographic location that remained signifi cant after controlling for severity of illness and patient sociodemogr aphic characteristics. Hospital and geographic variations in ICU utili zation may make it difficult to generalize ICU outcomes across differe nt hospitals.