AEGiS-11IAC: Physicians experience and utilization and cost of services among patients with AIDS.

11th International AIDS Conference

Vancouver, British Columbia — July 7-12, 1996

Physicians experience and utilization and cost of services among patients with AIDS.

Int Conf AIDS 1996 Jul 7-12; 11:19 (abstract no. We.B.174)
Kitahata MM, Koepsell TD, Deyo RA, Maxwell CL, Dodge WT, Wagner EH; University of Washington, Seattle, WA. Fax: (206)-720-4209. E-mail: kitahata@u.washington.edu.

OBJECTIVE: To determine the utilization of services and costs of care for patients with AIDS cared for by generalist physicians with increasing levels of experience in AIDS management. To examine whether patterns of resource utilization among physicians with greater AIDS experience contribute to survival among their patients.

METHODS: We examined utilization of services and costs for 220 adult men diagnosed with AIDS (1987 CDC surveillance case definition) within a staff-model health maintenance organization (HMO) from 1990 to 1994. One hundred eleven patients had records covering the entire course of disease from AIDS diagnosis to death. We defined three levels of physician experience according to residency training experience with AIDS care and the cumulative number of patients with AIDS cared for in practice. We analyzed costs and utilization of services by level of physician experience using Kruskal-Wallis comparison of ranks.

RESULTS: Our previous analysis of survival for patients in this study setting has shown that patients cared for by physicians with increasing AIDS experience had a significantly lower adjusted relative risk of mortality compared to patients cared for by physicians with less experience. Among 111 patients observed from the time of clinical AIDS diagnosis to death, we report that median utilization per year of primary care clinic visits, outpatient specialty consultations, hospital services and after hours clinic/urgent care shows a trend toward increased use with increasing physician experience. In particular, for patients cared for by physicians with least, moderate and most experience, the median number of primary care clinic visits per year are 12, 14.8 and 15.3, respectively (P=0.03); consultations with specialists are 1.1, 2.9 and 3.6 per year, respectively (P=0.07). Total cost (not charges) of medical care delivered within the HMO for patients cared for by physicians with least, moderate and most AIDS experience are as follows: $9,807, $20,847 and $21,844 per year from the time of clinical AIDS diagnosis to death (P=0.05).

CONCLUSIONS: This study demonstrates the importance of experience and associated differences in resource utilization among generalists managing the complex medical conditions associated with AIDS. Our findings suggest that increasing utilization of services and attributed costs may contribute to the longer survival reported for patients of the most experienced physicians in our study setting, and that physicians with less experience may underutilize services. This assessment of utilization and costs of HIV care forms the basis for cost-benefit analysis to delineate effective resource utilization within this model of care.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, Costs and Cost Analysis, Physicians, Health Maintenance Organizations, HIV Infections, Primary Health Care, Centers for Disease Control and Prevention (U.S.), Fees and Charges, Ambulatory Care, Risk, Managed Care Programs, Multivariate Analysis, Human, Male, Adult, utilization, economics, ICA11

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