AEGiS-08IAC: Dynamics of change in the HIV patient population and hospital care for HIV-infected patients: 1988-1989.

8th International AIDS Conference

Amsterdam, Netherlands — July 19-24, 1992

Dynamics of change in the HIV patient population and hospital care for HIV-infected patients: 1988-1989.

Int Conf AIDS 1992 Jul 19-24; 8:We51 (abstract no. WeC 1036)
Andrulis DP, Weslowski V, Hintz E, Spolarich A, Rathbun J; National Public Health and Hospital Institute, Washington, D.C.

OBJECTIVES: To compare, document and analyze hospital care for inpatients meeting the Centers for Disease Control (CDC) AIDS definition and other HIV-infected individuals not meeting these criteria, who were treated in U.S. hospitals during 1988 and 1989.

METHODS: Hospitals from four national associations, representing over 1100 acute care institutions (18% of all U.S. acute care hospitals) voluntarily participated in a comprehensive, ongoing national survey for both study years. Total response rates for both years were 60%. Analyses using primarily paired t-tests and Chi-Square focused on the following survey-based variables: number of distinct AIDS and HIV patients treated; utilization characteristics (length of stay, days/patient/year; admissions/year; mode of exposure; demographic characteristics; source of payment and other financial information. The two patient groups and the total burden of care (AIDS+HIV patients) were calculated and compared over the study years.

RESULTS: Hospitals reported AIDS and "other HIV" information on a total of 27,290 AIDS and HIV patients in 1988 and 29,141 in 1989. Declines occurred in the average number of patients treated (from 50 to 42/hospital for AIDS patients and from 34 to 32/hospital for OHIV patients), and in average length of stay for both groups (from 16.4 to 15.1 for AIDS patients and from 14.4 to 13.5 for HIV patients). Small increases occurred for homosexual drug users for both populations while other groups demonstrated marginal changes. Proportions of women remained within a percentage point (17% in 1988 and 16% in 1989 for total burden [AIDS+HIV]). The Caucasian populations of AIDS and Other HIV patients increased slightly while Hispanic AIDS patients and Black Other HIV patients declined slightly. Analysis of sources of payment between the study years indicated decreases in private institutions for AIDS and other HIV patients of 15% and 25% respectively, with increases spread through public payers for both groups, especially Medicare.

CONCLUSIONS: Hospitals appear to be making progress in reducing the number of hospital days of care required for both AIDS and other HIV patients. The lack of increase in the average number of patients may indicate that a peak has been reached in the upper limit of patients a hospital can treat (leading to a diffusion of patients to more hospitals) a spread in the epidemic and more reliance on outpatient facilities. Decrease in private sector support suggests a tightening of eligibility requirements, while increase in length of survival may allow additional numbers of AIDS and OHIV patients to claim disability. Implications include larger caseloads for "second tier" cities and hospitals and additional reliance on public sector support.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, Hospitalization, HIV Infections, Hospitals, HIV Seroprevalence, Population, Centers for Disease Control and Prevention (U.S.), Inpatients, Data Collection, Insurance, Hospitalization, United States, Human, Female, economics, ICA8
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