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