Physicians' experience with the acquired immunodeficiency syndrome as a factor in patients' survival

Article Abstract:

Increasing experience with AIDS patients among primary care providers appears to improve survival rates. Researchers correlated experience with treating AIDS patients with patient survival rates among 125 internists and family practitioners who cared for 403 HIV-positive men over a 10-year period. After 10 years, 39% of the doctors had minimal experience, having cared for only one AIDS patient, 42% had moderate experience, having cared for two to five patients, and 19% had the most experience, having cared for more than five patients. AIDS patients cared for by the most experienced doctors had one-third less risk of death than those cared for by minimally experienced doctors. The second AIDS patient cared for by any given doctor had 25% less risk of death than the first patient, and the risk of death was cut in half for the third patient. Increasing experience was associated with the use of preventative treatment for P. carinii pneumonia and closer follow-up of HIV-positive patients.

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Improving the outcomes of care for patients with human immunodeficiency virus infection

Article Abstract:

Improving survival rates in AIDS patients depends on having experienced doctors knowledgeable about the latest therapies in charge of the patient's care. A recent study of internists and family practitioners showed that the more AIDS patients a doctor treated, the longer the patients survived. Even so, patients in this study may not have been treated optimally. AIDS treatment has become increasingly complex and new strategies, more successful but also riskier and more highly technical, are constantly being developed. It is difficult for doctors who rarely treat AIDS patients to keep up. To improve the care of HIV-infected patients, health care organizations should assign HIV-infected patients to a few doctors within the organization, be they specialists or generalists, to ensure treatment by an experienced physician. They should also provide those doctors with access to the full panoply of drugs and laboratory tests.

Editorial

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The effect of Medicare's payment system for rehabilitation hospitals on length of stay, charges, and total payments

Article Abstract:

It appears that many rehabilitation hospitals deliberately manipulated their patients' length of stay and other factors in order to receive the maximum reimbursement from Medicare. The maximum reimbursement was based on the average charge per patient measured during a base year. Payments would be capped at that level thereafter but hospitals could receive an incentive for reducing the charges in succeeding years. However, the hospitals knew in advance when the base year would occur and analysis of Medicare claims data between 1987 and 1994 revealed that many hospitals increased their charges up to and during the base year, then decreased charges thereafter but never returned to the level prior to the base year.

Finance, Hospital utilization, Hospital stays, Medicare, Rehabilitation centers

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