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Hospital-based case management and directly observed therapy programs reduce readmission rates for tuberculosis.


Int Conf AIDS. 1996 Jul 7-12;11(1):167 (abstract no. Mo.C.1655). Unique

Objective: To assess the effect that hospital-based directly observed therapy (DOT) combined with case management intervention have in the compliance and outcome of patients dually infected with HIV and tuberculosis (TB).Setting: A 1500 bed inner-city hospital in Dade County, FL. A state-of-the-art respiratory isolation unit is used for outpatient clinic. Dade County probably has the highest incidence of patients dually infected with HIV and TB in the United States. Methods: In May of 1994 we instituted case management and DOT. A hospital-based nurse case manager oversaw a clinical pathway for tuberculosis. A program for hospital-based DOT and tracking of delinquent patients was instituted through a collaborative effort with the Dade County Health Department. We compared rates of readmission to the hospital for active TB for the 7 months before and after May 15, 1994. Results: The number of patients on DOT increased from 10 to 45. The rates of readmission for TB decreased from 11.5% to 1.5% p=0.0001). The rates of readmission for the HIV-respiratory clinic patients decreased from 18.75% to 0% (p=0.0001). Cost-benefit analysis revealed an estimated savings of $400,000. Conclusion: The institution of hospital-based DOT and case management is effective in increasing compliance and decreasing hospital readmission rates.

*Case Management *Patient Readmission *Tuberculosis/DRUG THERAPY


Information in this article was accurate in January 30, 1997. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.