EXPERIENCE WITH A MANAGED CARE APPROACH TO HIV-INFECTION - EFFECTIVENESS OF AN INTERDISCIPLINARY TEAM

To evaluate the function and effectiveness of a multidisciplinary team for managing human immunodeficiency virus (HIV) infection, we conduct ed a follow-up cohort study of HIV-positive patients managed according to a clinical care path at a staff-based health maintenance organizat ion (HMO), The study group consisted of 230 HIV-positive health plan m embers who received care at the Kaiser Permanente Santa Rosa medical c enter (KPMC-SRO), In 1994, the comparison group consisted of 4747 HIV- positive health plan members who received care at Kaiser Permanente's 18 other medical centers in northern California. The percentages of ac quired immunodeficiency syndrome (AIDS) and HIV-positive patients as d etermined by CD4+ T-cell counts were similar (P = 0.97), Compared with patients at the other Kaiser Permanente medical centers, KPMC-SRO pat ients had more visits with nurse practitioners (rate ratio [RR] = 1.72 ) and nutritionists (RR = 12.3) and fewer visits with primary care phy sicians (RR = 0.82), More HIV-positive members at KPMC-SRO received so cial workers' services (27% at KPMC-SRO vs 6% for patients at the othe r Kaiser Permanente medical centers) and fewer used emergency services (RR = 0.92) and psychiatric services (RR = .89), At KPMC-SRO, the mea n number of days that AIDS patients spent in the hospital decreased fr om 7.8 (1991) to 2.01 (1994), Hospital admissions were fewer (AIDS pat ients, RR = 0.67; HIV-positive patients without AIDS, RR = 0.45), and length of stay was briefer, compared with patients at the other Kaiser Permanente Medical Centers. The mean cost of HIV-related drugs for pa tients seen at KPMC-SRO ($2343 per infected member) was lower than tha t for patients seen elsewhere in the region ($3289 per infected member ). These results suggest that in an HMO setting, managed care provided by a dedicated interdisciplinary team according to a clinical care pa th can substantially and favorably affect resource use.