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AIDS patients fare much better in dedicated AIDS units and magnet hospitals compared with general hospital units

By 1988, 40 U.S. hospitals had established dedicated AIDS units, and one AIDS specialty hospital had opened. AIDS patients treated in dedicated AIDS units or nurse magnet hospitals have lower odds of dying within a month after admission, achieve greater satisfaction with their care, and receive care that meets professional standards. Nurse magnet hospitals emphasize nurse autonomy, nurse control over the practice setting, and good relations with physicians. Better nurse staffing, AIDS physician specialty services, and more organizational control by bedside nurses are the key to improved patient outcomes in specialized AIDS units and magnet hospitals, concludes Linda H. Aiken, Ph.D., R.N., of the University of Pennsylvania.

In a study supported in part by the Agency for Health Care Policy and Research (HS08603), Dr. Aiken and her colleagues compared differences in AIDS patients' 30-day mortality rates and care satisfaction in dedicated AIDS units, scattered-bed units in hospitals with and without dedicated AIDS units, and in magnet hospitals. The researchers obtained data on 1,205 patients in 40 units in 20 hospitals and on 820 of their nurses.

Compared with patients in conventional scattered-bed units, those in magnet hospitals had odds of dying that were lower by a factor of 0.40. Patients in dedicated AIDS units and scattered-bed units of hospitals with dedicated AIDS units had lower odds of dying by factors of 0.61 and 0.56, respectively. An additional nurse per patient day cut the odds of dying in 30 days by more than half. Even an increase of .25 nurse per patient day lowered by 20 percent the odds of dying within 30 days. The effect of having an AIDS specialty service was similarly pronounced. Patients whose physicians were not associated with an AIDS specialty service were roughly three times as likely to die in 30 days as patients whose physicians had such an association.

For more details, see "Organization and outcomes of inpatient AIDS care," by Dr. Aiken, Douglas M. Sloane, Ph.D., Eileen T. Lake, M.S.N., M.P.P., R.N., and others, in Medical Care 37(8), pp. 760-772.

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