Variations in intensive care unit utilization for patients with human immunodeficiency virus-related Pneumocystis carinii pneumoniaImportance of hospital characteristics and geographic location

摘要

ObjectiveTo determine whether intensive care unit (ICU) use and outcomes for patients with human immunodeficiency virus (HIV)-related Pneumocystis carinii pneumonia vary by hospital characteristics and geographic location.DesignRetrospective review of the medical records of 2,174 patients with HIV-related P. carinii pneumonia.SettingRandom sample of 73 private, nine public, and 14 Veterans Affairs hospitals in five cities (Chicago, New York, Los Angeles, Miami, and Durham, NC).PatientsStratified random sample of patients hospitalized with HIV-related P. carinii pneumonia from 1987 to 1990.InterventionsNone.Measurements and Main ResultsAmong the 2,174 patients with P. carinii pneumonia, 398 (18) patients received care in an ICU. ICU utilization varied significantly by patient and hospital characteristics, as well by as geographic location. Non-Hispanic whites, patients with Medicaid, and patients with a prior acquired immunodeficiency syndrome-defining illness were the least likely to receive care in an ICU. Patients in county- or state-owned hospitals and patients in hospitals with more P. carinii pneumonia-experience were also less likely to be cared for in an ICU. These differences in ICU utilization persisted when controlling for severity of illness, as well as other patient characteristics. Significant geographic variation in ICU utilization persisted after controlling for patient and hospital characteristics. Survival to hospital discharge after an ICU stay was significantly higher for patients without a prior acquired immunodeficiency syndrome-defining illness and for patients in hospitals with more P. carinii pneumonia experience.ConclusionsWe found significant variations in ICU utilization by hospital characteristics and geographic location that remained significant after controlling for severity of illness and patient sociodemographic characteristics. Hospital and geographic variations in ICU utilization may make it difficult to generalize ICU outcomes across different hospitals. (Crit Care Med 1998; 26:668-675)