Tuberculosis care in general hospitals: Arizona's experience

Area of Science:

• Public Health
• Infectious Disease Management
• Healthcare Policy

Background:

• Arizona transitioned tuberculosis (TB) patient care from a dedicated sanatorium to general hospitals in 1973.
• This shift involved contracting with general hospitals, extended care facilities, and physicians to manage TB patients.
• The program aimed to provide necessary hospital care without strict residency or indigency requirements.

Purpose of the Study:

• To evaluate the effectiveness and impact of transferring tuberculosis patient care to general hospitals in Arizona.
• To assess changes in length of stay, patient outcomes, costs, and healthcare worker safety.
• To gauge the acceptance of the new TB hospitalization program.

Main Methods:

• Analysis of data from the first two years of the Arizona Tuberculosis Hospitalization Program (1973-1975).
• Tracking patient admissions, lengths of stay, diagnoses, and discharge status.
• Monitoring hospitalization costs, insurance coverage, and employee skin testing conversion rates.

Main Results:

• A significant reduction in average length of hospital stay for TB patients, from 93 days to 23.6 days.
• Despite higher daily costs, the overall average hospitalization cost per patient decreased.
• A low conversion rate of 3.5% among hospital employees, with only 5 converters among those exposed to TB patients, and no employee tuberculosis cases.
• 65 out of 70 patients with active TB followed for 12-24 months became bacteriologically negative.

Conclusions:

• The general hospital model for TB care in Arizona proved effective, leading to shorter hospital stays and lower overall costs.
• The program demonstrated successful management of infectious tuberculosis patients within general hospital settings with minimal risk to healthcare workers.
• The initiative was well-received by patients, healthcare providers, and the public, indicating a successful public health policy shift.