Managed care plans often emphasize generalist outpatient care that does not maximize continuity between inpatient and outpatient settings. While this many be efficient for many types of patients, it may not be cost effective for those with complicated problems such as human immunodeficiency virus (HIV) infection. The aim of this study was to determine if the in-hospital charges and length of stay for patients with HIV infection were affected when supervision of inpatient care was changed from the usual ward-attending physician to a physician with HIV-specific experience who provided continuity of care. Before September 1996, HIV-infected patients attending a University- sponsored community clinic, when hospitalized, were cared for by the usual resident team supervised by a faculty member without special HIV experience. After that date, this inpatient care was supervised by the same HIV- experienced physicians who cared for the patients in the clinic. We compared the length of stay and hospital charges for admissions occurring over 6- month periods before and after this organizational change. Mean charges per hospitalization were reduced by $8,325 (36%) and median charges were reduced by $5,542 (40%) after the introduction of continuity of care by specialists. Median length of stay was reduced from 6 to 3 days. No increase in hospital death rate or rates of readmission was seen. Charges for HIV patients admitted from other providers, for whom the organization of care did not change, rose over the same time period. The introduction of continuity of care by physicians with specific, relevant HIV experience resulted in sharply lower inpatient charges for patients with HIV disease.
All Science Journal Classification (ASJC) codes
- Medicine (miscellaneous)