Barriers to out-of-hospital care for AIDS patients

Inappropriate delays in hospital discharge for AIDS patients add to the expense of health care, as well as to the stress felt by the patient. It has been postulated that delays are due to a lack of suitable out-of-hospital services and weak patient support networks. The charts of AIDS patients discharged from hospitals in northern New Jersey and southern New Jersey/Philadelphia, PA between 3/88 and 1/90 (n = 601 discharges for 454 patients) were examined to determine the discharge services or goods which were ordered and/or received, the extent of actual delay, and the causes of these delays. While regional variations were evident, differences in the profession of the discharge planner were associated with having care ordered and received and delays in discharge; as were availability of a support system, presence of a case manager, and race. A nurse or a social worker (as compared to a doctor as discharge planner) were more likely to effectively order and arrange out-of-hospital care, and were thus more likely to experience delays in hospital discharge. Failures of physicians to make timely requests for care were also associated with delays. Recommendations for future research were made.