Geographic variation in the management and outcome of patients with AIDS-related Pneumocystis carinii pneumonia.
Geographic variation in the management and outcome of patients with AIDS-related Pneumocystis carinii pneumonia.
复制标题
艾滋病相关卡氏肺孢子虫肺炎患者的治疗和结果存在地域差异。
DOI：
10.1097/00042560-199612150-00002
复制
发表时间：
1996
期刊：
影响因子：
--
通讯作者：
Bennett,CL
中科院分区：
文献类型：
--
作者：
Cohn,SE;Klein,JD;Weinstein,RA;Shapiro,MF;DeHovitz,JA;Kessler,HA;Dickinson,GM;Rodrigue,DC;Bennett,CL
卡氏肺囊虫肺炎（PCP）是艾滋病患者住院的最常见原因之一；然而，先前尚未评估 PCP 管理的地域差异。因此，我们从 1987 年至 1990 年间在芝加哥、洛杉矶、迈阿密、纽约市和北卡罗来纳州罗利-达勒姆的 82 家医院随机选择的 1547 名因艾滋病相关 PCP 住院的患者的病历中提取了有关社会经济特征、既往艾滋病毒治疗、疾病严重程度、住院治疗的及时性和强度、住院时间和生存率的数据。多变量回归模型用于评估与较长住院时间和住院死亡率增加相关的因素。我们的结果显示，院内死亡率为 15% 至 27%，支气管镜检查率为 53% 至 70%，平均住院时间为 14 天至 23 天。死亡率的地理差异是由入院时疾病严重程度、保险状况和住院患者管理的差异造成的。然而，即使在调整了患者人口统计数据、疾病严重程度以及诊断和治疗护理资源的使用之后，住院时间的显着区域差异仍然存在。 罗彻斯特大学医学系，纽约州罗彻斯特市；* 罗彻斯特大学儿科和社区与预防医学系，纽约州罗彻斯特市；† 库克县医院和拉什医学院医学系，伊利诺伊州芝加哥市；‡ 加州大学洛杉矶分校医学系，兰德公司，加利福尼亚州圣莫尼卡市； § 纽约州立大学健康科学中心医学系，纽约州布鲁克林；** 拉什医学院医学、免疫学和微生物学系，伊利诺伊州芝加哥；†† 迈阿密大学医学系，佛罗里达州迈阿密；‡‡ 南加州大学医学系，加利福尼亚州洛杉矶； §§ 美国伊利诺伊州芝加哥市西北大学医学系达勒姆退伍军人管理局医院健康服务研究部
Pneumocystis carinii pneumonia (PCP) is one of the most common reasons for the hospitalization of AIDS patients; however, geographic differences in PCP management have not been evaluated previously. Therefore, we abstracted data on socioeconomic characteristics, prior HIV care, severity of illness, timeliness and intensity of in-hospital care, duration of hospitalization, and survival from 1547 randomly selected medical records of patients hospitalized with AIDS-related PCP between 1987 and 1990 at 82 hospitals in Chicago, Los Angeles, Miami, New York City, and Raleigh-Durham, North Carolina. Multivariate regression models were used to assess factors associated with longer hospital stays and increased inpatient mortality. Our results showed that in-hospital mortality ranged from 15% to 27%, bronchoscopy rates from 53% to 70%, and mean length of stay from 14 days to 23 days. Geographic variations in mortality were accounted for by differences in severity of illness at admission, insurance status, and in-hospital patient management. However, significant regional variations in hospital length of stay persisted, even after adjusting for patient demographics, severity of illness, and use of diagnostic and therapeutic care resources.Department of Medicine, University of Rochester, Rochester, New York;* Department of Pediatrics and Community and Preventive Medicine, University of Rochester, Rochester, New York;† Department of Medicine, Cook County Hospital and Rush Medical College, Chicago, Illinois;‡ Department of Medicine, University of California, Los Angeles, RAND, Santa Monica, California; § Department of Medicine, State University of New York, Health Science Center, Brooklyn, New York;** Departments of Medicine, Immunology and Microbiology, Rush Medical College, Chicago, Illinois;†† Department of Medicine, University of Miami, Miami, Florida;‡‡ Department of Medicine, University of Southern California, Los Angeles, California; and §§ Division of Health Services Research, Durham Veterans Administration Hospital, Department of Medicine, Northwestern University, Chicago, Illinois, USA