HIV-experienced physicians may reduce hospital stays and cost of inpatient care

A study presented at the 44^th annual meeting of the Infectious Diseases Society of America has shown that doctors with more experience treating HIV are able to provide better outcomes of care for HIV-positive hospital inpatients, and may do so at less cost and use of resources.

It is well established that, for HIV-positive outpatients (those not in hospitals), doctors who are more experienced in treating HIV provide better outcomes than doctors with less HIV experience. In this study, conducted through the University of Chicago, researchers looked at whether HIV experience affected outcomes and use of hospital resources for hospital inpatients with HIV. They also looked at whether the type of care provider – ‘hospitalist’ vs. non-hospitalist – affected the same outcomes. (‘Hospitalist’ practitioners are doctors who spend more than half of their time caring for hospital inpatients.) They found that the amount of physician HIV experience affected outcomes, but it did not matter whether the physicians were ‘hospitalists’ or not.

The study looked at 1,191 HIV-positive patients admitted to six academic medical centres across the United States from 2001 to 2003. Researchers analysed the impact of three factors – the amount of physician experience, the type of provider (‘hospitalist’ vs. ‘non-hospitalist’), and whether or not the patient had an opportunistic infection (OI) – on three outcomes: how long the patient stayed in hospital, the cost and use of resources, and the health outcome for the patient. (Physician experience was defined as ‘high’ if they had cared for more than four patients with HIV. ‘Medium’ experience meant two to four patients, and ‘low’ if they had cared for one HIV-positive patient or none. This resulted in an even split between the three categories.)

Within the group of 1,191 patients, the mean age was 48 years, 38% were female, 52% were African-American, and 31% were Caucasian.

The researchers found that the type of physician – hospitalist or non-hospitalist – made little or no difference to most of the outcomes. Mortality rates, length of hospital stay, and the total dollar cost of care were not statistically different. The one difference noted was that non-hospitalists were considerably better (about 3-fold on the rating scale) at coordinating care with outpatient MDs after the patient’s release.

Mortality rates, the need for readmission, and patients’ self-reported satisfaction with their care were not affected by the category of physician experience. However, there was a tendency for ‘highly experienced’ physicians to result in shorter stays and less overall cost. These outcomes were not considered quite statistically significant, but suggested a trend. (Not surprisingly, patients with a diagnosed opportunistic infection (OI) were more likely to have a longer length of stay and higher cost.) Moderately or highly experienced doctors were significantly better at coordinating outpatient care.

The researchers concluded that “physician experience may affect cost and length of hospital stay in patients without OIs, but not mortality. Providers with increased experience taking care of HIV+ patients may decrease resource utilization irrespective of provider type.”