1060. Missed Opportunities and Costs Associated with Inpatient HIV Diagnosis
Session: Abstracts: HIV
Saturday, October 23, 2010
Background: Limited data on the impact of implementation of the revised 2006 HIV testing recommendations are available.  We evaluated factors associated with diagnosis site (Hospital vs. Outpatient), quantified prior hospital contacts (missed opportunities) and potentially avoidable costs had earlier diagnosis been performed.  

Methods: Newly diagnosed patients entering care at the 1917 HIV/AIDS Clinic 9/06–12/09 were categorized as Hospital [emergency room (ER) or inpatient] or Outpatient diagnoses.  Bivariate comparisons of patient characteristics by diagnosis category and multivariate (MV)_logistic regression analysis of factors associated with hospital diagnosis were performed.  Hospital visits (missed opportunities) in the two years prior to diagnosis, mean costs and lengths of stay were calculated for those diagnosed at UAB.  

Results: Among 300 newly diagnosed patients, 84 (28%) Hospital and 216 (72%) Outpatient diagnoses were identified.  Significant differences (p<0.05) in race (Black/Other 83% vs. 60%), insurance (Public 32% vs. 11%), initial CD4 levels (<200 60% vs. 23%), opportunistic infection <90 days from diagnosis (29% vs. 6%), were found between the Hospital vs. Outpatient diagnosis groups.  In MV analysis, public insurance (OR=8.7;95%CI=3.26-23.36), Black/Other race (5.0; 1.96-12.75), CD4 <200 (6.1; 2.53-14.90), early OI (6.6; 2.18-20.18), and no prior HIV test (2.2; 1.06-4.70) increased likelihood of hospital diagnosis.

Overall, 35% (n=29) of the Hospital group were diagnosed as inpatients at UAB.  Median length of stay and cost were 6 days (3; 9) and $23,230 (11,686; 43,162) respectively.  Among these patients, 52% (n=15) had prior UAB visits (missed opportunities) in the previous two years (10 admissions; 47 ER visits).

Conclusion: Sociodemographic disparities in hospital diagnosis of HIV were observed.  Over half of hospital diagnosed patients had prior missed opportunities for HIV screening.  Earlier diagnosis would potentially have avoided expensive inpatient hospitalizations during which HIV was diagnosed. These data lend support to the call for routine HIV testing in hospital settings.


Subject Category: H. HIV/AIDS and other retroviruses

Speakers:
S. Modi , University of Alabama at Birmingham, Birmingham, AL
James Willig, MD , University of Alabama at Birmingham, Birmingham, AL
A. Tamhane , University of Alabama at Birmingham, Birmingham, AL
C. Nevin , University of Alabama at Birmingham, Birmingham, AL
James Raper, PhD, NP , University of Alabama at Birmingham, Birmingham, AL
Michael Saag, MD, FIDSA , University of Alabama at Birmingham, Birmingham, AL
Michael Mugavero, MD , University of Alabama at Birmingham, Birmingham, AL

Disclosures:

S. Modi, None

J. Willig, None

A. Tamhane, None

C. Nevin, None

J. Raper, None

M. Saag, Yes
Adrea Pharmaceuticals: Consultant, Consulting fee
Avexa: Consultant, Consulting fee
Boehringer Ingelheim: Consultant and Grant Investigator, Consulting fee and Research grant
Bristol-Myers Squibb: Consultant and Grant Investigator, Consulting fee and Research grant
Gilead: Consultant and Grant Investigator, Consulting fee and Research grant
GlaxoSmithKline: Consultant and Grant Investigator, Consulting fee and Research grant
Merck: Consultant and Grant Investigator, Consulting fee and Research grant
Monogram Biosciences : Grant Investigator, Research grant
Pfizer: Consultant and Grant Investigator, Consulting fee and Research grant
Tanox: Consultant, Consulting fee
Tibotec: Consultant and Grant Investigator, Consulting fee and Research grant

M. Mugavero, Yes
Bristol Myers-Squibb: Grant Investigator and Scientific Advisor,
Gilead Sciences: Scientific Advisor,
Tibotec Therapeutics: Grant Investigator,
Pfizer: Grant Investigator,

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