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Medically unnecessary hospital use in children seropositive for human immunodeficiency virus
Insights
Many children with human immunodeficiency virus (HIV) experienced medically unnecessary hospitalizations. Improving outpatient and social services significantly reduced these hospital days for HIV+ children.
Area of Science:
- Pediatrics
- Public Health
- Health Services Research
Background:
- Reports indicated abandonment of children positive for human immunodeficiency virus (HIV) in hospitals.
- This study investigated unnecessary hospital utilization among HIV-positive children.
Purpose of the Study:
- To determine the extent and reasons for medically unnecessary hospital use in HIV-positive children.
- To assess the impact of improved services on hospital utilization rates.
Main Methods:
- Retrospective review of inpatient stays for all HIV-positive children at Yale-New Haven Hospital through October 31, 1987.
- Application of the Pediatric Appropriateness Evaluation Protocol to assess the medical necessity of hospital days.
Main Results:
- 54% of hospital days for 34 eligible HIV-positive children were deemed medically unnecessary.
- Unnecessary use was highest for one-day stays (gamma-globulin infusions) and long stays (>3 weeks) due to placement issues.
- Unnecessary hospital days decreased from 64% (1983-1984) to 30% (1987) with enhanced services.
Conclusions:
- Medically unnecessary hospital days for HIV-positive children are substantial but reducible.
- Improved outpatient medical care and social services, including foster care access, decrease hospital utilization.
- Further enhancements in medical and social support systems can significantly lower costs associated with unnecessary hospital care for this population.
Abstract:
Stimulated by reports that some children who are seropositive for human immunodeficiency virus (HIV+) have been abandoned in the hospital, we studied the extent of, and reasons for, medically unnecessary hospital use at Yale-New Haven (Conn) Hospital among HIV+ children. We reviewed inpatient stays for all HIV+ children hospitalized through Oct 31, 1987. Hospital days were judged to be unnecessary if they failed to meet any of the criteria on the Pediatric Appropriateness Evaluation Protocol. Among 34 children eligible for the study, 54% of their hospital days were judged medically unnecessary; 59% of the children had at least one such day. Unnecessary use was 100% for one-day stays (all for gamma-globulin infusions) and 58% for stays longer than three weeks, with 94% of those unnecessary days being secondary to placement problems. The rate of unnecessary days has declined from 64% of all hospital days in 1983 and 1984 to 30% in 1987 as a result of improved outpatient services and access to foster care. Improved medical and social services could substantially reduce the cost of medically unnecessary hospital care in HIV+ children.