Outcomes of HIV/AIDS case management in New York.

The purpose of this study was to examine HIV case management (CM) outcomes in New York State. The results presented here are part of a larger study that explored: client needs identified during CM, success in arranging needs, other case managers used by the client, coordination between multiple case managers, client satisfaction with CM, and the correlation between health care costs and CM. This paper focuses on the linkage of clients with services. Twenty-eight agencies and 588 clients participated in the study. Each client's chart was reviewed; clients and case managers were interviewed. Almost 9,000 client needs were identified; 79.3% of these needs were for services. Over 72% of needed services were arranged for clients. However, of the services arranged, 12.9% were never utilized. Success in arranging services did not vary based on client demographics; client utilization of services, once arranged, varied based on only one demographic factor (clients who lived outside of New York City had higher utilization rates than those who lived in the city, p < or = 0.05). Services provided directly by the CM agency were arranged and utilized more frequently than services provided by another agency (p < or = 0.05). Medical needs were arranged and utilized at a higher rate-and legal needs at a lower rate-than other services, regardless of where the service was provided (p < or = 0.05). On average it took 2.3 months to arrange a service; however it took less time to arrange medical services and more time to arrange legal services (p < or = 0.05). Females, individuals whose mode of HIV transmission was heterosexual contact, clients whose children were living with them, the inadequately housed, and those without a high school diploma had significantly more needs than other clients (p < or = 0.05). Our study supports CM models that provide intensive services to women with children; the provision of multiple services, in addition to CM, within a single agency; and the need for case manager training on how to work with clients to increase service utilization.

Cultural analysis of an organ procurement organization.

Organ procurement organizations are a critical link in the acquisition, placement, and transport of human organs for transplantation. Employed within the organ procurement organizations are organ transplant coordinators and support staff who constitute the front line in the challenge to diminish the gap between the supply and demand for organs. Responsibilities are emotionally and physiologically demanding as employees regularly face death and grieving families with empathy and commitment. This study describes and interprets dominant themes embedded in the culture of one such organ procurement organization, geographically located in northeastern United States. The authors used ethnographic research methods to understand the shared meaning system of the members of this organization. Identified themes included coping and sharing, conflicting priorities and uncertainty, and mission and reward. The influence of each theme on the organization is discussed with prescriptive implications for managerial practice.

Predictors of California nursing facilities' acceptance of people with HIV/AIDS.

OBJECTIVE: To examine factors that might predict the provision of HIV/AIDS care among California nursing facilities (NFs) in 1990. STUDY DESIGN: Logistic regression to examine the probability that a NF had admitted a person with AIDS/HIV (PWA/H). Independent variables of key interest included whether the facility was hospital-based; whether it sustained a financial loss in FY 1990; whether it had a hospice; the percentage of its residents on Medicare; the percentage of its residents on MediCal; the number of PWA/Hs per elderly in the county where the facility was located; the ratio of home-based hospices to elderly in the county; and the ratio of NF beds to elderly in the county. DATA COLLECTION METHODS: Data on all California NFs, obtained from the Office of Statewide Health Planning and Development (OSHPD), were merged with state data on the cumulative incidence of AIDS cases by county; U.S. census data on the number of elderly by county; and home-based hospice data from the 1990 Case Management Resource Guide for California. PRINCIPAL FINDINGS: Of the 902 facilities examined, 7.65 percent served AIDS residents. The financial loss variable was not significant. The community-based hospice variable was significant and negative. All other key variables were significant and positive. CONCLUSIONS: This study (1) suggests that NFs respond to external pressures to provide AIDS care even in the absence of financial incentives or a positive financial margin; (2) supports concerns that competition may exist between the elderly and PWA/H for NF beds; (3) shows that NFs are less likely to provide care if substitute services are available; and (4) demonstrates that facilities capable of providing a higher level of clinical and psychosocial care may be particularly willing, perhaps able, to provide AIDS care.

Defining the challenges of providing long-term care: the case of the nursing home industry's response to the AIDS epidemic.

Acquired Immune Deficiency Syndrome (AIDS) is now viewed as a chronic disease requiring long-term management. As a result, more persons with AIDS (PWAs) are seeking long-term care in facilities that have primarily served the elderly. In some regions, however, the nursing home market into which PWAs may introduce new demand is a market already characterized by excess demand. In light of this, competition for limited long-term care resources may develop between the frail elderly and PWAs. The nursing home industry has raised many issues regarding the feasibility of admitting AIDS patients as residents, but little is known about how important these issues are in deciding admissions policy. How the industry perceives and resolves the concerns it has regarding delivery of care to PWAs can affect the overall long-term care system and thus affect the traditional users-the frail elderly. Knowing the concerns and preferences of the industry may help guide and anticipate future changes in the system. In this pilot study, a random sample of 250 nursing home administrators in the five highest AIDS-incidence areas in the United States was surveyed to determine (1) the industry's concerns and issues regarding AIDS care, (2) data regarding requests for admission by PWAs to nursing homes, and (3) data concerning the industry's preferred way of delivering AIDS care. Important admissions policy issues cited by the respondents included the ability to meet special care needs, costs of care, and inadequate reimbursement. The majority also believed the most appropriate methods of providing care were special care units for AIDS within nursing homes or dedicated HIV/AIDS nursing facilities.