VARIATIONS BETWEEN RURAL AND URBAN AIDS CARE

对艾滋病患者护理的变化可能会导致过度的 发病率和死亡率以及住院费用。 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的重点是 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 在较低流行率地区，罗利-达勒姆，北 卡罗莱纳，并将我们的发现与四个艾滋病高发地区的发现进行比较， 流行城市 该项目的主要目标有三个方面：（1） 确定因PCP住院的艾滋病患者的死亡率 在罗利-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、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赞助的 艾滋病临床试验单位、支付者组合和医院经验 艾滋病患者）;（2）将我们的研究结果与 正在进行的四个城市艾滋病研究， 在洛杉矶、芝加哥、纽约住院的艾滋病相关PCP患者， 迈阿密;（3）评估地理因素如距离的作用 医院护理或生活在农村地区，在预测获得护理， 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， 四城市艾滋病研究 本研究将回顾300名艾滋病患者的病历 在16个非退伍军人管理局（VA）中的任何一个因PCP住院 从1987年1月1日起，位于北卡罗来纳州的罗利-达勒姆医疗服务局的医院 到1990年12月1日。这些信息将与类似数据合并 从正在进行的AHPCR和VA资助的4个城市的质量研究中获得， 艾滋病相关PCP患者的护理，创建五个城市艾滋病研究 数据库，从该数据库可以执行分析， 艾滋病高发区。 此外，本研究将使用 塞西尔G. Sheps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 照顾艾滋病患者。

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.