PMID- 31077218 OWN - NLM STAT- MEDLINE DCOM- 20190718 LR - 20200225 IS - 1472-6963 (Electronic) IS - 1472-6963 (Linking) VI - 19 IP - 1 DP - 2019 May 10 TI - HIV/AIDS length of stay in Portugal under financial constraints: a longitudinal study for public hospitals, 2009-2014. PG - 303 LID - 10.1186/s12913-019-4131-0 [doi] LID - 303 AB - BACKGROUND: The global financial crisis and the economic and financial adjustment programme (EFAP) forced the Portuguese government to adopt austerity measures, which also included the health sector. The aim of this study was to analyse factors associated with HIV/AIDS patients' length of stay (LOS) among Portuguese hospitals, and the potential impact of the EFAP measures on hospitalizations among HIV/AIDS patients. METHODS: Data used in this analysis were collected from the Portuguese database of Diagnosis Related Groups (DRG). We considered only discharges classified under MCD 24 created for patients with HIV infection. A total of 20,361 hospitalizations occurring between 2009 and 2014 in 41 public hospitals were included in the analysis. The outcome was the number of days between hospital admission and discharge dates (LOS). Hierarchical Poisson regression model with random effects was used to analyse the relation between LOS and patient, treatment and setting characteristics. To more effectively analyse the impact of the EFAP implementation on HIV/AIDS hospitalizations, yearly variables, as well as a variable measuring hospitals' financial situation (current ratio) was included. RESULTS: For the 5% level, having HIV/AIDS as the principal diagnosis, the number of secondary diagnoses, the number of procedures, and having tuberculosis have a positive impact in HIV/AIDS LOS; while being female, urgent admission, in-hospital mortality, pneumocystis pneumonia, hepatitis C, and hospital's current ratio contribute to the decrease of LOS. Additionally, LOS between 2010 and 2014 was significantly shorter in comparison to 2009. Differences in LOS across hospitals are significant after controlling for these variables. CONCLUSION: Following the EFAP, a number of cost-containment measures in the health sector were implemented. Results from our analysis suggest that the implementation of these measures contributed to a significant decrease is LOS among HIV/AIDS patients in Portuguese hospitals. FAU - Augusto, Goncalo F AU - Augusto GF AD - Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical - Universidade NOVA de Lisboa (IHMT-UNL), Rua da Junqueira 100, 1349-008, Lisbon, Portugal. figueiredo.augusto@ihmt.unl.pt. FAU - Dias, Sara S AU - Dias SS AD - Epidoc Unit - CEDOC, NOVA Medical School - Universidade Nova de Lisboa (NMS-UNL), Campo Martires da Patria 130, 1169-056, Lisbon, Portugal. AD - Center for Innovative Care and Health Technology (ciTechCare), Escola Superior de Saude de Leiria (ESSLei), Instituto Politecnico de Leiria (IPLeiria), Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901, Leiria, Portugal. FAU - Abrantes, Alexandre V AU - Abrantes AV AD - Health Policy and Administration Department, Escola Nacional de Saude Publica - Universidade NOVA de Lisboa (ENSP-UNL), Avenida Padre Cruz, 1600-560, Lisbon, Portugal. FAU - Martins, Maria R O AU - Martins MRO AD - Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical - Universidade NOVA de Lisboa (IHMT-UNL), Rua da Junqueira 100, 1349-008, Lisbon, Portugal. LA - eng PT - Journal Article DEP - 20190510 PL - England TA - BMC Health Serv Res JT - BMC health services research JID - 101088677 SB - IM MH - Adult MH - Cost Control MH - Databases, Factual MH - Female MH - *HIV Infections MH - Health Care Costs/trends MH - Hospitalization/economics MH - Hospitals, Public/*economics MH - Humans MH - Length of Stay/*economics/*trends MH - Longitudinal Studies MH - Male MH - Middle Aged MH - Patient Discharge MH - Portugal PMC - PMC6511190 OTO - NOTNLM OT - Austerity OT - HIV/AIDS OT - Hospitals OT - LOS OT - Portugal COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: This study was approved by the Ethics Committee of the Institute of Hygiene and Tropical Medicine (Conselho de Etica do Instituto de Higiene e Medicina Tropical), as part of the PhD project by GFA. The full project protocol was submitted to the Ethics Committee in April 2016 and approved in May 2016. The study used data routinely collected in Portuguese public hospitals. The DRG database was requested to the ACSS - MCD = 24 (HIV/AIDS infection) only, for the years 2009-2014 - and was sent to the authors completely anonymized. Therefore, the authors cannot identify any subject on that database. The Central Administration of the Health System (ACSS) is the legal owner of the DRG database in Portugal. CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2019/05/12 06:00 MHDA- 2019/07/19 06:00 PMCR- 2019/05/10 CRDT- 2019/05/12 06:00 PHST- 2018/04/23 00:00 [received] PHST- 2019/04/29 00:00 [accepted] PHST- 2019/05/12 06:00 [entrez] PHST- 2019/05/12 06:00 [pubmed] PHST- 2019/07/19 06:00 [medline] PHST- 2019/05/10 00:00 [pmc-release] AID - 10.1186/s12913-019-4131-0 [pii] AID - 4131 [pii] AID - 10.1186/s12913-019-4131-0 [doi] PST - epublish SO - BMC Health Serv Res. 2019 May 10;19(1):303. doi: 10.1186/s12913-019-4131-0.