Long-term care needs of hospitalized persons with AIDS: a prospective cohort study.

Abstract

OBJECTIVE: As the treatment for HIV infection has improved, AIDS has become a chronic disease, and the demand for long-term care has increased. The authors studied a cohort of hospitalized persons with AIDS to determine the proportion and characteristics of AIDS patients who could appropriately be cared for in long-term care facilities with skilled nursing. DESIGN: Prospective cohort study. SETTING: Medical wards of five Seattle tertiary care hospitals. PARTICIPANTS: 120 consecutive hospitalized persons with AIDS and their primary care physicians, nurses, and social workers. MEASUREMENTS AND MAIN RESULTS: Appropriateness for long-term care was determined by the patients' physicians, nurses, and social workers. Persons with AIDS who were appropriate for long-term care constituted 32% of the cohort (38 of 120), accounting for 35% of hospital days (11 of these 38 were discharged to long-term care facilities). Four admission characteristics were independently related to appropriateness: impaired activities of daily living, diagnosis of central nervous system illness or poor cognition, living alone, and weight loss. A discriminant function correctly classified over 80% of patients for appropriateness and was developed into a predictive index for planning patient care (sensitivity = 0.74, specificity = 0.85). CONCLUSIONS: The authors conclude that one-third of hospitalized persons with AIDS may be appropriate for care in long-term care settings, accounting for one-third of the days AIDS patients currently spend in hospitals. These patients can be identified early in hospital stays using a simple predictive index at the bedside.