VARIATIONS BETWEEN RURAL AND URBAN AIDS CARE

艾滋病患者护理的差异可能会导致过度 发病率、死亡率和住院费用。许多先前的研究 解决艾滋病患者的护理质量和资源使用问题 在受艾滋病疫情影响最严重的地区。利用卡氏肺孢子虫 肺炎(PCP)作为艾滋病的模型，我们计划研究护理的变化 北罗利-达勒姆较低流行区的艾滋病患者的PCP 卡罗莱纳州，并将我们的发现与四个艾滋病高发区的结果进行比较 流行城市。这个项目的主要目标有三个：(1) 为确定感染卡介苗的艾滋病患者的死亡率 罗利-达勒姆地区受以下因素影响：(A)患者特征 (包括年龄、性别、种族、艾滋病危险行为、医疗保险、严重程度 疾病、农村居住地和到医院的距离)，以及(B)医院 特征(包括教学状态、是否有NIH赞助的 艾滋病临床试验单位、付款人组合和医院的经验 爱滋病患者)；。(2)将我们的研究结果与 正在进行的四个城市的艾滋病研究，检查患者护理的变化 与艾滋病相关的PCP在洛杉矶、芝加哥、纽约和 迈阿密；以及(3)评估地理因素的作用，如距离 医院护理或生活在农村地区，在预测获得护理的机会时， 这些北卡罗来纳州的疾病严重程度和患者死亡率 医院以及在艾滋病高发城市检查 四个城市的艾滋病研究。 这项研究将回顾300名艾滋病患者的医疗记录 因PCP在16个非退伍军人管理局(VA)中的任何一个住院 北卡罗来纳州罗利-达勒姆MSA医院自1987年1月1日起 一直到1990年12月1日。这些信息将与类似的数据合并 来自正在进行的AHPCR和退伍军人事务部资助的4个城市的质量研究 护理HIV相关PCP患者，创建五个城市的艾滋病研究 可从中执行分析的数据库，可检查较低和 艾滋病高发区。此外，这项研究将使用 塞西尔大学农村卫生项目的研究人员的专业知识。 希普斯卫生服务研究中心开发和应用方法 评估地理因素在理解变异中的重要性 在照顾艾滋病患者方面。

Variations in the care of patients with AIDS may contribute to excessive morbidity and mortality and in-hospital costs. Much of the prior research addressing quality of care and resource use in AIDS patients has focused on areas hardest hit by the AIDS epidemic. Using Pneumocystis carinii pneumonia (PCP) as a model for AIDS, we plan to study variations in care of AIDS patients with PCP in a lower prevalence area, Raleigh-Durham, North Carolina, and to compare our findings to those seen in four high AIDS prevalence cities. The principal goals of this project are three-fold: (1) to determine how mortality in AIDS patients who are hospitalized with PCP in the Raleigh-Durham area is affected by: (a) patient characteristics (including age, sex, race, AIDS risk behaviors, health insurance, severity of illness, rural residence, and distance to hospitals), and (b) hospital characteristics (including teaching status, presence of an NIH-sponsored AIDS Clinical Trial Unit, payor mix, and the hospitals' experience with AIDS patients); (2) to compare our findings to those obtained in the ongoing Four-City AIDS Studies which examine variations in care of patients with AIDS-related PCP hospitalized in Los Angeles, Chicago, New York, and Miami; and (3) to evaluate the role of geographic factors such as distance to hospital care or living in a rural area, in predicting access to care, severity of illness, and patient mortality in these North Carolina hospitals as well as in the high prevalence AIDS cities examined in the Four-City AIDS Studies. This study will review the medical records of 300 AIDS patients hospitalized for PCP at any of the 16 non-Veterans Administration (VA) hospitals in the Raleigh-Durham MSA in North Carolina from January 1, 1987 through December 1, 1990. The information will be merged with similar data obtained from the ongoing AHPCR and VA funded 4-City Study of Quality of Care for Patients with HIV-related PCP, creating a Five City AIDS Study database from which analyses may be performed examining both lower and higher AIDS prevalence areas. In addition, this study will use the expertise of researchers within the Rural Health Program at the Cecil G. Sheps Center for Health Services Research to develop and apply methods for evaluating the importance of geographic factors in understanding variations in care for AIDS patients.