Does experience improve hospital performance in treating patients with AIDS?

This paper examines how experience affects hospital performance in treating patients with AIDS. The most common life-threatening medical complication of AIDS is Pneumocystis carinii pneumonia (PCP). Studies of patients with PCP demonstrate that patients who received care at hospitals that were more experienced with AIDS had lower immediate mortality. These higher volume medical facilities did not use more resources but used resources more efficiently and provided better medical care. Better outcomes for experienced providers suggest three policy implications for improving quality of patient care: (1) create regionalized centers where large numbers of patients with a particular illness are treated; (2) encourage low volume providers to rapidly increase their experience; or (3) establish targeted educational programs for low volume providers. Historical review of experience with other medical problems such as tuberculosis indicate that one policy option, creating regional medical centers, did not have the desired effect of better patient outcomes. These facts support policies to provide targeted educational programs and opportunities for low volume facilities to rapidly increase their familiarity with AIDS. Outcomes could be improved by such policies.