Tuberculosis care in general hospitals: Arizona's experience.

In June 1973 the state of Arizona transferred all in-hospital care of patients with tuberculosis from the State Sanatorium to general hospitals. Eleven general hospitals, 2 extended care facilities, and 30 physicians are under contract; the state pays billed charges after payment from any third-party insurers. Admission to the Tuberculosis Hospitalization Program is controlled by the state and requires real evidence of need for hospital care; there are no residency or indigency requirements. During the first 2 years of the program, 279 patients were admitted for hospital care. The average length of stay was 23.6 days; a marked decrease from the 93-day average in the sanatorium in 1971-1972. Of the 274 patients discharged during the first 2 years, 232 had a final diagnosis of tuberculosis; 105 of these were discharged with sputum smears positive for acid-fast bacilli. Although the cost per patient day was higher than in the sanatorium, the average cost of hospitalization per patient was lower because of the decrease in length of stay. Thirty-five per cent of the patients had some insurance coverage and/or Medicare. An employee skin testing program was required in all hospitals participating in the program. Although there was a 3.5 per cent conversion rate among all hospital employees, there were only 5 converters among employees exposed to patients with tuberculosis under the program. None of the employees was found to have tuberculosis. Of 70 patients with active tuberculosis who have been followed 12 to 24 months, 65 are bacteriologically negative. The general hospital program has been well accepted by patients, physicians, hospitals, and the public.