The relationship of clinic experience with advanced HIV and survival of women with AIDS

Christine Laine, Leona E. Markson, Linda J. McKee, Walter W. Hauck, Thomas R. Fanning, Barbara J. Turner

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Objective: Hospital and physician experience have been linked to improved outcomes for persons with HIV. Because many HIV-infected patients receive care in clinics, we studied clinic HIV experience and survival for women with AIDS. Design: Retrospective cohort study of women with AIDS whose dominant sources of care were clinics. Clinic HIV experience was estimated as the cumulative number of Medicaid enrollees with advanced HIV who used a particular clinic as their dominant provider up to the year of the patient's AIDS diagnosis: low experience (< 20 patients), medium (20-99 patients), high (≤ 100 patients). Proportional hazards models examined relationships between experience and survival. Setting: A total of 117 New York State clinics. Patients: A total of 887 New York State Medicaid-enrolled women diagnosed with AIDS in 1989-1992. Main outcome measure: Survival after AIDS diagnosis. Results: In later study years (1991-1992), patients in high experience clinics had an approximately 50% reduction in the relative hazard of death (0.53; 95% confidence interval, 0.35-0.82) compared with patients in low experience clinics. Adjusting for demographic and clinical variables, 71% of patients in high experience clinics were alive 21 months after diagnosis compared with 53% in low experience clinics. Experience and survival were not significantly associated in the early study years (1989-1990). Conclusions: In more recent years, women with AIDS receiving care in high experience clinics survived longer after AIDS diagnosis than those in low experience clinics, providing further evidence of a relationship between provider HIV experience and outcomes.

Original languageEnglish (US)
Pages (from-to)417-424
Number of pages8
JournalAIDS
Volume12
Issue number4
StatePublished - Mar 5 1998
Externally publishedYes

Fingerprint

Acquired Immunodeficiency Syndrome
HIV
Survival
Medicaid
Proportional Hazards Models
Patient Care
Cohort Studies
Retrospective Studies
Demography
Outcome Assessment (Health Care)
Confidence Intervals
Physicians

Keywords

  • AIDS
  • Ambulatory care
  • Epidemiology
  • Health care
  • HIV
  • Medicaid

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Laine, C., Markson, L. E., McKee, L. J., Hauck, W. W., Fanning, T. R., & Turner, B. J. (1998). The relationship of clinic experience with advanced HIV and survival of women with AIDS. AIDS, 12(4), 417-424.

The relationship of clinic experience with advanced HIV and survival of women with AIDS. / Laine, Christine; Markson, Leona E.; McKee, Linda J.; Hauck, Walter W.; Fanning, Thomas R.; Turner, Barbara J.

In: AIDS, Vol. 12, No. 4, 05.03.1998, p. 417-424.

Research output: Contribution to journalArticle

Laine, C, Markson, LE, McKee, LJ, Hauck, WW, Fanning, TR & Turner, BJ 1998, 'The relationship of clinic experience with advanced HIV and survival of women with AIDS', AIDS, vol. 12, no. 4, pp. 417-424.
Laine C, Markson LE, McKee LJ, Hauck WW, Fanning TR, Turner BJ. The relationship of clinic experience with advanced HIV and survival of women with AIDS. AIDS. 1998 Mar 5;12(4):417-424.
Laine, Christine ; Markson, Leona E. ; McKee, Linda J. ; Hauck, Walter W. ; Fanning, Thomas R. ; Turner, Barbara J. / The relationship of clinic experience with advanced HIV and survival of women with AIDS. In: AIDS. 1998 ; Vol. 12, No. 4. pp. 417-424.
@article{a942ae4b02524dde90e1cdd5ab894dfb,
title = "The relationship of clinic experience with advanced HIV and survival of women with AIDS",
abstract = "Objective: Hospital and physician experience have been linked to improved outcomes for persons with HIV. Because many HIV-infected patients receive care in clinics, we studied clinic HIV experience and survival for women with AIDS. Design: Retrospective cohort study of women with AIDS whose dominant sources of care were clinics. Clinic HIV experience was estimated as the cumulative number of Medicaid enrollees with advanced HIV who used a particular clinic as their dominant provider up to the year of the patient's AIDS diagnosis: low experience (< 20 patients), medium (20-99 patients), high (≤ 100 patients). Proportional hazards models examined relationships between experience and survival. Setting: A total of 117 New York State clinics. Patients: A total of 887 New York State Medicaid-enrolled women diagnosed with AIDS in 1989-1992. Main outcome measure: Survival after AIDS diagnosis. Results: In later study years (1991-1992), patients in high experience clinics had an approximately 50{\%} reduction in the relative hazard of death (0.53; 95{\%} confidence interval, 0.35-0.82) compared with patients in low experience clinics. Adjusting for demographic and clinical variables, 71{\%} of patients in high experience clinics were alive 21 months after diagnosis compared with 53{\%} in low experience clinics. Experience and survival were not significantly associated in the early study years (1989-1990). Conclusions: In more recent years, women with AIDS receiving care in high experience clinics survived longer after AIDS diagnosis than those in low experience clinics, providing further evidence of a relationship between provider HIV experience and outcomes.",
keywords = "AIDS, Ambulatory care, Epidemiology, Health care, HIV, Medicaid",
author = "Christine Laine and Markson, {Leona E.} and McKee, {Linda J.} and Hauck, {Walter W.} and Fanning, {Thomas R.} and Turner, {Barbara J.}",
year = "1998",
month = "3",
day = "5",
language = "English (US)",
volume = "12",
pages = "417--424",
journal = "AIDS",
issn = "0269-9370",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - The relationship of clinic experience with advanced HIV and survival of women with AIDS

AU - Laine, Christine

AU - Markson, Leona E.

AU - McKee, Linda J.

AU - Hauck, Walter W.

AU - Fanning, Thomas R.

AU - Turner, Barbara J.

PY - 1998/3/5

Y1 - 1998/3/5

N2 - Objective: Hospital and physician experience have been linked to improved outcomes for persons with HIV. Because many HIV-infected patients receive care in clinics, we studied clinic HIV experience and survival for women with AIDS. Design: Retrospective cohort study of women with AIDS whose dominant sources of care were clinics. Clinic HIV experience was estimated as the cumulative number of Medicaid enrollees with advanced HIV who used a particular clinic as their dominant provider up to the year of the patient's AIDS diagnosis: low experience (< 20 patients), medium (20-99 patients), high (≤ 100 patients). Proportional hazards models examined relationships between experience and survival. Setting: A total of 117 New York State clinics. Patients: A total of 887 New York State Medicaid-enrolled women diagnosed with AIDS in 1989-1992. Main outcome measure: Survival after AIDS diagnosis. Results: In later study years (1991-1992), patients in high experience clinics had an approximately 50% reduction in the relative hazard of death (0.53; 95% confidence interval, 0.35-0.82) compared with patients in low experience clinics. Adjusting for demographic and clinical variables, 71% of patients in high experience clinics were alive 21 months after diagnosis compared with 53% in low experience clinics. Experience and survival were not significantly associated in the early study years (1989-1990). Conclusions: In more recent years, women with AIDS receiving care in high experience clinics survived longer after AIDS diagnosis than those in low experience clinics, providing further evidence of a relationship between provider HIV experience and outcomes.

AB - Objective: Hospital and physician experience have been linked to improved outcomes for persons with HIV. Because many HIV-infected patients receive care in clinics, we studied clinic HIV experience and survival for women with AIDS. Design: Retrospective cohort study of women with AIDS whose dominant sources of care were clinics. Clinic HIV experience was estimated as the cumulative number of Medicaid enrollees with advanced HIV who used a particular clinic as their dominant provider up to the year of the patient's AIDS diagnosis: low experience (< 20 patients), medium (20-99 patients), high (≤ 100 patients). Proportional hazards models examined relationships between experience and survival. Setting: A total of 117 New York State clinics. Patients: A total of 887 New York State Medicaid-enrolled women diagnosed with AIDS in 1989-1992. Main outcome measure: Survival after AIDS diagnosis. Results: In later study years (1991-1992), patients in high experience clinics had an approximately 50% reduction in the relative hazard of death (0.53; 95% confidence interval, 0.35-0.82) compared with patients in low experience clinics. Adjusting for demographic and clinical variables, 71% of patients in high experience clinics were alive 21 months after diagnosis compared with 53% in low experience clinics. Experience and survival were not significantly associated in the early study years (1989-1990). Conclusions: In more recent years, women with AIDS receiving care in high experience clinics survived longer after AIDS diagnosis than those in low experience clinics, providing further evidence of a relationship between provider HIV experience and outcomes.

KW - AIDS

KW - Ambulatory care

KW - Epidemiology

KW - Health care

KW - HIV

KW - Medicaid

UR - http://www.scopus.com/inward/record.url?scp=0032485327&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032485327&partnerID=8YFLogxK

M3 - Article

C2 - 9520172

AN - SCOPUS:0032485327

VL - 12

SP - 417

EP - 424

JO - AIDS

JF - AIDS

SN - 0269-9370

IS - 4

ER -