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Current trends in HIV-related hospital admissions and their impact on hospital resource utilization in Ontario
M J Hyland1, G Bailey, M Rawji
1Department of Medicine, Wellesley Hospital, Toronto, Ont.
Objective:
To assess changes in patterns of hospital admissions, in frequency of admissions and in average length of stay (ALOS) at a tertiary HIV referral centre, and to investigate the overall impact of care for patients with HIV infection of AIDS on peer hospitals in Ontario.
Design:
Descriptive study.
Participants:
Data were obtained on patients with HIV infection or AIDS treated at the Wellesley Hospital in Toronto for the fiscal years (May 1 to Apr. 31) 1990-91, 1991-92 and 1992-93, and on admissions for HIV or AIDS in 9 peer hospitals in Ontario during the same period.
Interventions:
For the Wellesley Hospital, review of medical records of HIV-related admissions to determine the reasons for admission and to examine concurrent illnesses. For the Wellesley Hospital Hospital and peer hospitals, analysis of changes in ALOS and Resource Intensity Weights (RIWs).
Results:
Between May 1, 1990, and Apr. 31, 1993, the number of admissions for treatment of Pneumocystis carinii pneumonia (PCP) fell, but admissions for respiratory infections other than PCP remained very common, although they decreased slightly. Overall, infection remained the main reason for admission. The frequency of gastrointestinal complications necessitating admission increased. The frequency of admissions remained high, although the ALOS decreased significantly. In the period between Apr. 1, 1991, and Mar. 31, 1994, the proportion of HIV-related discharges and total hospital discharges among the 9 peer hospitals remained stable. The HIV-related ALOS decreased substantially. Although the HIV-related average RIW decreased slightly, this measure and the mortality rate are still much higher for HIV-related admissions than for overall admissions.
Conclusions:
This contemporary survey suggests that nonrespiratory infection complications have become the main reason for admission of patients with HIV infection or AIDS, but that the HIV tertiary hospitals are coping with the load of HIV-related admissions and the high average RIW associated with these patients by reducing the ALOS.