Quality of Medical Care for Patients with AIDS and Cancer

This Note presents the results of three studies that illustrate different approaches to evaluating quality of care for patients with acquired immune deficiency syndrome (AIDS) and cancer. The first AIDS study identified marked variations in in-hospital death rates for individuals with pneumocystis carinii pneumonia. It suggests that hospitals that treat more patients with a particular disease are more likely to achieve better outcomes. The second study used the same dataset as the first to explore the association of hospital AIDS familiarity with resource use. Results show that physicians and staff appear to use resources more efficiently in hospitals with a higher degree of AIDS familiarity. Data from the third study, which evaluated older men with prostate cancer, indicated that older men were less likely than younger men to receive an intensive diagnostic evaluation or therapy for their cancer. The studies have important policy implications for medical care providers. They indicate that variations in resource use and quality of care exist for both younger and older patients with terminal diseases, and they illustrate the diversity of quality-of-care assessments, which generally focus on one of two aspects of medical care: process or outcome.