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SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements:
Volume 3, Issue 20 (October 2, 1998)
This document has been superceded by our Online Knowledge Base on Innovative Models of HIV/AIDS Care. Click here to access the Knowledge Base. Click here to access descriptions of 27 Innovative Models of HIV/AIDS Care and the lessons learned from these projects. SPNS/Fax was written, published, and distributed by fax by The Measurement Group between 1995 and 1998. |
Information dissemination from 27 Innovative Models of HIV Care projects funded as Special Projects of National Significance by the HIV/AIDS Bureau (HAB) of the Health Resources and Services Administration (HRSA).
Introduction
Welcome to SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements. In each issue of SPNS/Fax, we will highlight findings from the HRSA Special Projects of National Significance Program Cooperative Agreements. The projects have been funded to develop innovative models of HIV/AIDS care. SPNS/Fax reports are distributed every two weeks by fax machine to all subscribers. All issues of SPNS/Fax are also available at this Web site. Due to slight differences in the media, issues distributed by fax machine may appear slightly different from those posted on this Web site, but the content is identical.
East Boston Determines the Impact of Risk Factor and Disease Stage on Service Utilization
The East Boston Neighborhood Health Center (EBNHC) provides community-based integrated primary and specialty care to persons with HIV and AIDS through Project SHINE (Support, Healthcare, Intervention, Education). With current changes in health care financing, payment for much of Project SHINE's health services will soon change from fee-for-service to a capitated managed care plan. In order for EBNHC to negotiate a capitation rate that will enable it to continue to provide quality care, EBNHC must understand the service use and costs associated with this program. To this end, Project SHINE has analyzed the service use of plan members in relation to disease stage, risk group, and changes over time.
Project SHINE served 128 people between October 1994 and October 1997. Of the patients served by Project SHINE, over half were insured by Medicaid and one quarter had no insurance. Injection drug use was the primary risk factor for almost half of the members, and almost 90 percent had mental health or substance abuse issues at some point during the program. In terms of outpatient service use, the number of primary, specialty and urgent care visits stayed fairly stable over time; however, the use of laboratory procedures, x-rays, and medical procedures rose, which may reflect changes in standards of care for the frequency of those procedures and the type of measures used for determining disease status, such as viral load testing.
How does disease stage impact service utilization? Overall, the number of hospital admissions per member per year, days per member per year, and average length of stay decreased over the 3 years analyzed. Overall, days per member per year decreased from 3.7 per year in FY 94-95 to 2.4 per year in FY 96-97. Average length of stay decreased from 8.4 days per year in the first year to 5.7 days per year in the third year. Hospital days per member per year have changed depending on disease stage. As shown in Figure 1, the number of hospital days per member per year declined from 10.9 to 3.5 days per year for enrollees with AIDS, while increasing from 0.0 to 1.3 for people with symptomatic HIV infection, and from .8 to 2.9 for people with asymptomatic HIV infection.
How do risk factors impact service utilization? The effects of risk factor on hospitalizations are dramatic. As compared to other risk groups, injection drug use is associated with a much higher percentage of hospital admissions than the other two risk categories (see Figure 2). The decrease in admissions for people with AIDS may be partially explained by highly active anti-retroviral therapy (HAART), while the high number of admissions for people with asymptomatic HIV infection may be explained by injection drug use or other co-morbid conditions.
Both risk factors and disease stage play an important role in service utilization and must be considered in setting capitation rates that support the provision of high quality, comprehensive, and cost effective health care.
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