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Kathi Kemper, MD, MPH; Brian Forsyth, MB, ChB

JAMA. 1988;260(13):1906-1909.

Abstract
Stimulated by reports that some children who are seropositive for human immunodeficiency virus (HIV + ) have been abandoned in the hospital, we studied the extent of, and reasons for, medically unnecessary hospital use at Yale—New Haven (Conn) Hospital among HIV + children. We reviewed inpatient stays for all HIV + children hospitalized through Oct 31, 1987. Hospital days were judged to be unnecessary if they failed to meet any of the criteria on the Pediatric Appropriateness Evaluation Protocol. Among 34 children eligible for the study, 54% of their hospital days were judged medically unnecessary; 59% of the children had at least one such day. Unnecessary use was 100% for one-day stays (all for -globulin infusions) and 58% for stays longer than three weeks, with 94% of those unnecessary days being secondary to placement problems. The rate of unnecessary days has declined from 64% of all hospital days in 1983 and 1984 to 30% in 1987 as a result of improved outpatient services and access to foster care. Improved medical and social services could substantially reduce the cost of medically unnecessary hospital care in HIV + children.

(JAMA 1988;260:1906-1909)

Author Affiliations
From the Division of General Pediatrics, the Department of Pediatrics, Yale University School of Medicine, New Haven, Conn. Dr Kemper is now with the Department of Pediatrics, University of Washington, and Harborview Medical Center, Seattle.

Footnotes
Reprint requests to Department of Pediatrics, Harborview Hospital, 325 Ninth Ave, Seattle, WA 98104 (Dr Kemper).

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