Through 1995, over 500,000 people have been diagnosed with AIDS in this country, with 60% of these patients having already died. These totals are currently increasing by 3% per year and are expected to climb to over 550,000 and 340,000, respectively, by the end of the decade. Of the reported cases 32% are associated with intravenous drug use, a demographic that is disproportionately represented in racial and socioeconomic minorities. injection drug use (IDU) associated AIDS cases made up 44% of all AIDS cases for blacks, 48% for Hispanics and 65% for women, in comparison to only 16% for white men. During the same period, several costly new pharmaceuticals and treatment strategies for AIDS and its complications have been introduced that have succeeded in prolonging the lives of these patients. This combination of demographic inequities and improvements in treatment modalities, particularly when coupled with the current surge toward managed care, raise concerns about the distribution of medical resources. The assessment of variations in patterns of care and resource use is essential to providing quality medical treatment equitably for the thousands infected with this disease. This study proposes a three year, 1994-1996, retrospective evaluation of quality of care, outcomes and resource use for patients with AIDS, focusing on the treatment of first episode Pneumoystis carnii pneumonia (PCP), one of the most common and serious illnesses contracted by people with AIDS. It is intended to build on earlier research on quality of care by investigating how mortality, resource use, and care processes are affected by patient, hospital, physician and geographic characteristics. Using validated methodology for evaluating PCP care, developed by core members of the current proposal, efforts will be focused on assessing the quality of care for important subgroups of patients, particularly intravenous drug users, racial minorities, and insurance subgroups. From this information, the following issues will be specifically considered, 1) how do IDUs compare to other risk groups for quality of in-hospital care, use of resources, and mortality rates, 2) how do insurance status, severity of illness and patient and hospital characteristics affect the outcomes of each of these risk groups, and 3) what effect will Medicaid managed care programs have on the quality of AIDS care.
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