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Physician experience may influence outcomes of hospitalized patients with HIV disease more than hospital HIV experience

Patients undergoing complex procedures typically fare better at hospitals that perform many of those procedures. For patients hospitalized with HIV disease, physician HIV experience seems to be more important than hospital HIV experience, suggests a new study by Fred Hellinger, Ph.D., of the Agency for Healthcare Research and Quality (AHRQ).

Dr. Hellinger analyzed discharge data from 43,325 patients hospitalized with HIV disease in 5 States in 2002, based on AHRQ's Healthcare Cost and Utilization Project State Inpatient Databases. One-half of all patients were cared for in a hospital that treated fewer than 597 HIV-positive patients during the year, and half of them were treated by a physician who treated fewer than 17 HIV-positive patients during the year (only 5 percent of physicians treat more than that).

The probability of dying in the hospital was 6 percent and the average length of stay was nearly 9 days. The probability of dying in the hospital shrank by 3 percent for each increase of 100 HIV-positive patients treated by a hospital, and it decreased by 2.4 percent for each increase of 10 HIV-positive patients treated by a physician. However, the effect of hospital volume became insignificant when physician volume was included in the equation. This makes sense, given that the continual stream of new HIV medications and other factors prompt rapidly changing standards for treating these patients.

It is more difficult for doctors who treat only a small number of patients with HIV disease to keep abreast of and assimilate these changes into their practice, explains Dr. Hellinger. His is the first volume-outcome study of hospitalized patients with HIV disease that used data collected after diffusion of highly active antiretroviral therapy in 1996 and 1997.

See "Practice makes perfect: A volume-outcome study of hospital patients with HIV disease," by Dr. Hellinger, in the February 1, 2008 Journal of Acquired Immunodeficiency Syndrome 47(2), pp. 226-233.

Reprints (AHRQ Publication No. 08-R052) are available from the AHRQ Publications Clearinghouse.

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