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Medical-Resource Use for Suspected Tuberculosis in a New York City Hospital

Published online by Cambridge University Press:  02 January 2015

Robert I. Griffiths*
Affiliation:
Covance Health Economics and Outcomes Services Inc, Washington, DC Program for Medical Technology and Practice Assessment, Johns Hopkins University School of Medicine, Baltimore, Maryland
Charles L. Hyman
Affiliation:
The State University of New York, Health Science Center at Brooklyn, Brooklyn, New York Kings County Hospital Center, Brooklyn, New York Medicalliance, Inc, Columbia, Maryland
Samy I. McFarlane
Affiliation:
The State University of New York, Health Science Center at Brooklyn, Brooklyn, New York Kings County Hospital Center, Brooklyn, New York
Guillermo R. Saurina
Affiliation:
The State University of New York, Health Science Center at Brooklyn, Brooklyn, New York Kings County Hospital Center, Brooklyn, New York
Jane E. Anderson
Affiliation:
Medicalliance, Inc, Columbia, Maryland
Theodore O'Brien
Affiliation:
Becton Dickinson and Company, Franklin Lakes, New Jersey
Caroline Popper
Affiliation:
Becton Dickinson and Company, Franklin Lakes, New Jersey
Margaret M. McGrath
Affiliation:
Covance Health Economics and Outcomes Services Inc, Washington, DC
Robert J. Herbert
Affiliation:
Covance Health Economics and Outcomes Services Inc, Washington, DC
Marcelino F. Sierra
Affiliation:
The State University of New York, Health Science Center at Brooklyn, Brooklyn, New York Kings County Hospital Center, Brooklyn, New York
*
Covance Health Economics and Outcomes Services Inc, 1100 New York Ave NW, Suite 200 E, Washington, DC 20005-3934; e-mail [email protected]

Abstract

Objective:

To compare resource use by diagnostic outcome among hospital admissions during which tuberculosis (TB) was suspected.

Design:

Retrospective study based on chart review and microbiology laboratory data.

Setting:

The department of medicine in a municipal hospital serving central Brooklyn, New York.

Participants:

We identified all adult admissions in 1993 during which TB was suspected. We assigned each admission to one of four mutually exclusive groups defined by the results of microbiological tests (acid-fast bacilli [AFB] smear and culture): culture-positive and smear-positive (C + S +); culture-positive and smear-negative (C + S−); culture-negative and smear-positive (C−S+); or culture-negative and smear-negative (C−S−). Each admission was divided into two separate periods to which the utilization of medical resources was assigned: the diagnostic and the postdiagnostic periods, which were separated by the date of receipt of the first definitive culture report.

Results:

Data on 519 admissions (93 C+S+; 57 C+S−; 30 C−S+; and 339 C−S−) were analyzed. Although C+S+ were more likely than other groups to have an admitting diagnosis of TB, approximately one quarter of the admissions without TB (C−S+, C−S−) were admitted with the principal diagnosis of TB. For the four groups, C+S+, C+S−, C−S+, and C−S−, the respective rates of TB isolation and anti-TB treatment, and median lengths of isolation were 98%, 87%, and 34 days; 74%, 74%, and 7 days; 83%, 83%, and 15 days; and 44%, 29%, and 0 days. During the diagnostic period, the rate and length of isolation were similar in the AFB-smear—positive groups (C+S+ and C−S+). We estimated that admissions without culture-proven TB (C−S+ and C−S−) accounted for 3,174 (36%) of the 8,712 days of TB isolation expended and for 65% of the 16,671 days of anti-TB treatment. The vast majority of this resource consumption (2,737 [86%] of 3,174 days of isolation) occurred during the diagnostic period before a definitive culture result was known.

Conclusions:

Our results suggest that prolonged diagnostic uncertainty and misclassification of cases due to false-positive and false-negative smears are associated with substantial medical-resource consumption. New diagnostic modalities that reduce the period of diagnostic uncertainty could reduce the utilization of resources later found to be unnecessary

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

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