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The Influence of Health-Related Quality of Life and Social Characteristics on Hospital Use by Patients with AIDS in the Boston Health Study

WEISSMAN, JOEL*,†; CLEARY, PAUL*,∥; SEAGE, GEORGE‡,§; GATSONIS, CONSTANTINE*; HAAS, JENNIFER; CHASAN-TABER, SCOTT*; EPSTEIN, ARNOLD*,†,¶

Original Article

OBJECTIVES The authors examine whether health-related quality of life (HRQL) and social factors were independent predictors of future hospital use for persons with acquired immunodeficiency syndrome (AIDS).

METHODS A panel of 305 patients with AIDS treated at three provider settings in the Boston, Massachusetts area were enrolled during 1990 and 1991. Data were collected at baseline study enrollment and again 4 months later. Patient interviews, hospital bills, and medical charts were used to measure hospital use (admissions and days during the 4 months after enrollment), sociodemographic characteristics (age, gender, race, education, insurance, homelessness, alcohol use, and AIDS risk factors), disease burden (patient severity and a three-level opportunistic diseases and complications score), HRQL (patient-reported symptoms, activities of daily living, neuropsychological status, and global health assessment), system of care, and use of prophylactic drugs. Logistic regression was used to estimate the odds of admission. Total days of hospital care by patients with at least one admission were analyzed using multiple linear regression. Clinical models of hospital use were developed first from the variables measuring disease burden and system of care. Models estimating the associations between hospital use and all other predictor variables measured at baseline then were estimated using stepwise techniques, controlling for variables in the core model.

RESULTS Patients were more likely than their reference groups to be hospitalized if they had serious opportunistic diseases (adjusted odds ratio [OR] = 2.7), had poorer neuropsychological status (OR = 1.9), were nonwhite (OR = 2.0), or were homeless (OR = 3.3) (all P ≤ 0.05). Activities of daily living were associated moderately (OR = 1.3; P = 0.07). Only system of care and neuropsychological status predicted total hospital days.

CONCLUSIONS The results indicate that future hospital use by persons with AIDS may be influenced by social and other health-related factors in addition to the more clinically related characteristics that are recorded in a medical chart. It therefore may be appropriate to assess these factors when considering options for intervention or when comparing patterns of use among patient groups or settings.

*From The Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.

From the Division of General Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.

From the Institute for Urban Health Policy and Research, Boston Department of Health and Hospitals, Boston, Massachusetts.

§From the Department of Epidemiology and Biostatistics, Boston University School of Public Health, Boston, Massachusetts.

From the Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts.

From The Department of Social Medicine, Harvard Medical School, Boston, Massachusetts.

Supported by Agency for Health Care Policy and Research, grant #HS06239.

A version of this article was presented at the Annual Meeting of the American Public Health Association, Medical Care Section; October 1993; San Francisco, California.

Address correspondence to: Joel S. Weissman, PhD, Department of Health Care Policy, 25 Shattuck St., Parcel B, 1st Floor, Boston, MA 02115.

© Lippincott-Raven Publishers