S. Bakken et al., A comparison of three strategies for risk-adjustment of outcomes for AIDS patients hospitalized for Pneumocystis carinii pneumonia, J ADV NURS, 30(6), 1999, pp. 1424-1431
Background: The need for risk-adjustment of patient outcomes has been drive
n by the competitive health care market and the subsequent increase in comp
arative outcome reporting among health care institutions, among managed car
e plans, and among individual providers for some procedures (e.g. coronary
artery bypass graft surgery). However, if the outcomes reported do not take
into account patient characteristics that can be considered dimensions of
risk for poor clinical outcomes or increased utilization of services, there
is the possibility that inaccurate conclusions will be drawn about the qua
lity of care provided. Objective: The specific purpose of this study was to
examine the ability of four measures, APACHE III - acute physiology scale,
Quality Audit Marker - ambulation score, Quality Audit Marker - self-care
ability score, and Nursing Severity Index, to predict mortality and hospita
l length of stay in a convenience sample of 140 males with Pneumocystis car
inii pneumonia. Methods: The study utilized a descriptive, longitudinal des
ign. Results: APACHE III - acute physiology scale (P = 0.006, odds ratio =
1.40), and Quality Audit Marker - ambulation (P = 0.037, odds ratio = 0.50)
, were significant predictors of hospital mortality and the APACHE III - ac
ute physiology scale was also a predictor of mortality within 3 (P = 0.004,
odds ratio = 1.13) and 6 months (P = 0.009, odds ratio = 1.10) following h
ospitalization. Only Quality Audit Marker - ambulation (P = 0.0001) was a s
ignificant predictor of length of stay. Conclusions: The findings of this s
tudy confirm the findings of other investigators that measures of acute cli
nical stability and functional status have utility as risk-adjustment appro
aches for the outcomes of mortality and length of stay. Further research is
needed that compares the utility of generic vs. disease-specific measures
for prediction of outcomes in HIV/AIDS.