An Economic Analysis of Two Models of Hospital Care for AIDS Patients: Implications for Hospital Discharge Planning

Marianne C. Fahs, M.P.H., Ph.D., Associate Professor and Director of Health Economics, Mt. Sinai Medical Center

Kathy Wade, M.S.W., Assistant Director of Social Work Services at Columbia Presbyterian Medical Center

The development of cost effective models of hospital care and discharge planning for people with HIV is a vital policy issue. However, almost no data exist evaluating cost and quality differences in alternate hospital models of care. This empirical study retrospectively evaluates social work discharge planning for patients with HIV disease in two hospital care models: a cluster AIDS unit and general inpatient site beds. The independent effect of each hospital model of care on length of stay is assessed in a multivariate analysis, controlling for level of care needs and other social and clinical factors. Results reveal that the cluster AIDS unit, where a specialized AIDS social work staff works in collaboration with the interdisciplinary aids team, is associated with a significant reduction in hospital length of stay for persons with HIV disease and complex discharge planning needs. These results support the hypothesis that discharge planning services, performed by specialized social workers, are a cost effective investment for hospitals treating patients with complex chronic conditions, such as AIDS. Further research should be developed to systematically evaluate the cost effectiveness of hospital-based social workers, using prospective experimental designs, in order to establish the net impact of social work discharge planning services on patient and family outcomes and institutional and social costs.

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