       Document 0870
 DOCN  M9620870
 TI    Relationship between procedures and health insurance for critically ill
       patients with Pneumocystis carinii pneumonia [see comments]
 DT    9602
 AU    Horner RD; Bennett CL; Rodriguez D; Weinstein RA; Kessler HA; Dickinson
       GM; Johnson JL; Cohn SE; George WL; Gilman SC; et al; Division of Health
       Services Research, Durham Veterans; Administration Hospital, NC, USA.
 SO    Am J Respir Crit Care Med. 1995 Nov;152(5 Pt 1):1435-42. Unique
       Identifier : AIDSLINE MED/96048794
 CM    Comment in: Am J Respir Crit Care Med 1995 Nov;152(t Pt 1):1433-4
 AB    The objective of the present study was to assess the association between
       type of health insurance coverage and use of diagnostic tests and
       therapies among patients with AIDS-related Pneumocystis carinii
       pneumonia (PCP). Fifty-six private, public, and community hospitals in
       Chicago, Los Angeles, and Miami were selected for the study, and the
       charts of 890 patients with empirically treated or cytologically
       confirmed PCP, hospitalized during 1987 to 1990 were retrospectively
       reviewed. Patients were classified by insurance status: self-pay (n =
       56), Medicaid (n = 254), or private insurance, including health
       maintenance organizations and Medicare (n = 580). Primary outcomes were
       the use and timing of bronchoscopy, the type and timing of PCP therapy,
       and in-hospital mortality. The results indicate that Medicaid patients
       were less likely than privately insured patients to undergo bronchoscopy
       (relative odds = 0.61; 95% CI = 0.40, 0.93; p = 0.02) or to have their
       diagnosis of PCP confirmed (relative odds = 0.51; 95% CI = 0.33, 0.77),
       after adjusting for patient, severity of illness, and hospital
       characteristics. Medicaid patients were approximately three-fourths more
       likely than privately insured patients (relative odds = 1.73; 95% CI =
       1.01, 2.96; p = 0.04) to die in-hospital, after adjusting for patient,
       severity of illness, and hospital characteristics. However, with further
       adjustment for confirmation of PCP, Medicaid patients no longer had a
       significantly higher likelihood of dying in-hospital. We conclude that
       Medicaid patients are less likely to receive diagnostic bronchoscopy
       than privately insured or self-insured patients, more likely to be
       empirically treated for PCP, and more likely to die
       in-hospital.(ABSTRACT TRUNCATED AT 250 WORDS)
 DE    Adult  AIDS-Related Opportunistic Infections/*DIAGNOSIS/*ECONOMICS/
       MORTALITY/THERAPY  Bronchoscopy/ECONOMICS/STATISTICS & NUMER DATA
       Chicago/EPIDEMIOLOGY  Critical Illness  Female  Florida/EPIDEMIOLOGY
       Health Services Accessibility/*ECONOMICS/STATISTICS & NUMER DATA
       Hospital Mortality  Hospitalization/ECONOMICS/STATISTICS & NUMER DATA
       Human  *HIV-1  *Insurance,
       Hospitalization/CLASSIFICATION/ECONOMICS/STATISTICS &  NUMER DATA  Los
       Angeles/EPIDEMIOLOGY  Male  Middle Age  Outcome and Process Assessment
       (Health Care)/ECONOMICS/STATISTICS  & NUMER DATA  Pneumonia,
       Pneumocystis carinii/*DIAGNOSIS/*ECONOMICS/MORTALITY/  THERAPY  Quality
       of Health Care/ECONOMICS/STATISTICS & NUMER DATA  Retrospective Studies
       Support, U.S. Gov't, Non-P.H.S.  Support, U.S. Gov't, P.H.S.  JOURNAL
       ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

