VARIATIONS BETWEEN RURAL AND URBAN AIDS CARE

农村和城市艾滋病护理的差异

• 批准号: 3427850
• 负责人: SUSAN E COHN
• 金额: $ 7.85万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 1992
• 资助国家: 美国
• 起止时间: 1992-09-30 至 1994-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3427850
• 关键词: AIDS; Pneumocystis pneumonia; ethnic group; gender difference; health care quality; health care service utilization; human age group; human mortality; human subject; medical records; patient care management; rural area; urban area

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.

艾滋病患者护理的差异可能会导致过度治疗 发病率和死亡率以及住院费用。 之前的大部分研究 解决艾滋病患者的护理质量和资源利用问题已成为重点 重点关注艾滋病疫情最严重的地区。 使用卡氏肺孢子虫 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-达勒姆低流行地区艾滋病患者患有 PCP 的比例 卡罗莱纳州，并将我们的发现与四种艾滋病高发人群的发现进行比较 流行城市。 该项目的主要目标有三个：（1） 确定因 PCP 住院的艾滋病患者的死亡率 罗利-达勒姆地区受到以下因素的影响： (a) 患者特征 （包括年龄、性别、种族、艾滋病危险行为、健康保险、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（包括教学状况、NIH 资助的机构的存在） 艾滋病临床试验单位、付款人组合以及医院的经验 艾滋病患者）； (2) 将我们的研究结果与其他研究中获得的结果进行比较 正在进行的四城市艾滋病研究，旨在检查患者护理方面的差异 与艾滋病相关的 PCP 在洛杉矶、芝加哥、纽约和 迈阿密; (3) 评估距离等地理因素的作用 去医院护理或生活在农村地区，预测获得护理的机会， 北卡罗来纳州的疾病严重程度和患者死亡率 医院以及艾滋病高发城市的调查 四城市艾滋病研究。 这项研究将审查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 自 1987 年 1 月 1 日起，北卡罗来纳州罗利-达勒姆 MSA 的医院 到 1990 年 12 月 1 日。该信息将与类似数据合并 取自正在进行的 AHPCR 和 VA 资助的 4 城市质量研究 护理 HIV 相关 PCP 患者，开展五城市艾滋病研究 可以从中进行分析的数据库，检查较低和 艾滋病流行率较高的地区。 此外，本研究将使用 Cecil G. 农村卫生项目研究人员的专业知识。 谢普斯健康服务研究中心开发和应用方法 评估地理因素在理解差异方面的重要性 致力于照顾艾滋病患者。

项目成果

Variations in institutional review board decisions for HIV quality of care studies: a potential source of study bias.

机构审查委员会对艾滋病毒护理质量研究决策的差异：研究偏差的潜在来源。

• DOI: 10.1097/00126334-200104010-00019
• 发表时间: 2001
• 期刊: Journal of acquired immune deficiency syndromes (1999)
• 作者: Bennett,CL;Sipler,AM;Parada,JP;Goetz,MB;DeHovitz,JA;Weinstein,RA
• 通讯作者: Weinstein,RA

Geographic variation in the management and outcome of patients with AIDS-related Pneumocystis carinii pneumonia.

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
• 发表时间: 1996
• 期刊: Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association
• 作者: Cohn,SE;Klein,JD;Weinstein,RA;Shapiro,MF;DeHovitz,JA;Kessler,HA;Dickinson,GM;Rodrigue,DC;Bennett,CL
• 通讯作者: Bennett,CL

Gender differences in early suspicion of tuberculosis in hospitalized, high-risk patients during 4 epidemic years, 1987 to 1990.

1987年至1990年4个流行年中住院高危患者早期怀疑结核病的性别差异。

• DOI: 10.1086/647601
• 发表时间: 1997
• 期刊: Infection control and hospital epidemiology
• 影响因子: 4.5
• 作者: Cegielski,JP;Goetz,MB;Jacobson,JM;Cohn,SE;Weinstein,RA;DeHovitz,JA;Bennett,CL
• 通讯作者: Bennett,CL

Empirically treated Pneumocystis carinii pneumonia in Los Angeles, Chicago, and Miami: 1987-1990.

洛杉矶、芝加哥和迈阿密经验性治疗卡氏肺孢子虫肺炎：1987-1990 年。

• DOI: 10.1093/infdis/172.1.312
• 发表时间: 1995
• 期刊: The Journal of infectious diseases
• 作者: Bennett,CL;Horner,RD;Weinstein,RA;Kessler,HA;Dickinson,GM;Pitrak,DL;Gilman,SC;George,WL;Cohn,SE;Simberkoff,MS
• 通讯作者: Simberkoff,MS