Community Hospital In New York Research Articles

Asthma Outcome Measures Before and After the COVID-19 Outbreak Among the Pediatric Population in a Community Hospital.

BackgroundThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is a global health threat that has affected patient care enormously. Moderate to severe asthma was listed as a risk factor for severe SARS-CoV-2 disease by the Centers for Disease Control. Little is known about the impact of the pandemic on asthma control in children, particularly African American children.ObjectiveThe present study sought to determine how changes during the coronavirus disease 2019 (COVID-19) pandemic affected asthma metrics in a majority African American pediatric population at a pediatric pulmonology clinic in a community hospital in New York.MethodsThis is a retrospective, pre-post, comparative cross-sectional study that included children three to 18 years of age with a known diagnosis of asthma followed in a pulmonary clinic. Data were gathered from electronic medical records. Subjects were selected if they presented to a pulmonology clinic within a certain time window both before and after the outbreak of the COVID-19 pandemic. Outcome variables included asthma medication statistics and healthcare utilization statistics.ResultsInclusion criteria were met by 104 pediatric patients. The majority were African American. Emergency department visits, primary physician visits, and hospitalizations significantly decreased in the post-COVID study group compared to the pre-COVID control group.ConclusionAmong a majority African American pediatric population, there were significant improvements in asthma outcomes after COVID-19 societal changes when compared to before COVID-19 based on outcome variables.

Unprecedented Training: Experience of Residents During the COVID-19 Pandemic

Unprecedented Training: Experience of Residents During the COVID-19 Pandemic

Weight Loss Outcomes following Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in an Ethnically Diverse Bariatric Population: Which Is More Effective?

Background Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) have comparable weight loss outcomes in a general bariatric population. Objectives This study aimed to investigate whether similar outcomes can be observed in Hispanic and African American population. Settings. Community Hospital in New York, New York, United States. Methods The 5-year prospective data of patients who underwent LRYGB and LSG at a single center were retrospectively reviewed. The long-term weight loss outcomes between patients who had LRYGB and LSG were compared after adjusting for age, sex, race, diabetes mellitus, and hypertension with the linear mixed-effects or logistic regression model. Results Most patients were Hispanic (59.2%) and African American (22.7%). The mean% total weight loss (%TWL) values of patients with BMI <45 kg/m2 who underwent LRYGB and LSG were 73% and 62% after 1 year, 69% and 56% after 2 years, and 71% and 54% after 5 years, respectively. In patients with a BMI of 45–50 kg/m2 who underwent LRYGB and LSG, the mean %TWL values were 69% and 56% after 1 year, 75% and 58% after 2 years, and 57% and 45% after 5 years, respectively. Meanwhile, the %TWL values of patients with BMI >50 kg/m2 who had LRYGB and LSG were 53% and 42% after 1 year, 53% and 45% after 2 years, and 49% and 36% after 5 years, respectively. All results were statistically significant (p < 0.0001) and remained valid after adjusting for cofactors. Conclusion Thus, LRYGB had consistent and sustained long-term weight loss outcomes compared with LSG in a predominantly ethnically diverse patient population with different BMI. Our study had several limitations in that it is retrospective in nature and some patients were lost to follow-up during the study period.

NEED FOR FEEDS: EARLY ENTERAL FEEDING IN MECHANICALLY VENTILATED, CRITICALLY ILL PATIENTS

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Current guidelines recommend early enteral nutrition during critical illness within 24 to 48 hours of admission. The purpose of our study was to investigate the percent of patients admitted to our medical ICU (MICU) who received enteral nutrition within 48 hours of mechanical ventilation and to investigate barriers to administering optimal enteral nutrition. METHODS: We conducted a single-center, retrospective chart review of patients over the age of 18 who were admitted to the MICU in our academic community hospital in New York, NY and mechanically ventilated between July 1, 2019 and November 30, 2019. Patients who had nasogastric or percutaneous endoscopic gastrostomy feeding tubes placed prior to intubation, patients with tracheostomies, and those intubated for fewer than 48 hours were excluded. Contraindications to tube feeds were based on the ESICM 2017 clinical practice guidelines. An anonymous, electronic survey of internal medicine resident physicians was conducted to assess perception and knowledge of enteral feeding. RESULTS: Of 128 patients, 63 were excluded, the majority excluded due to length of intubation less than 48 hours. The average age of the included 65 patients was 68 years, 55% (36/65) male and 45% (29/65) female. The three most common admitting diagnoses were sepsis or septic shock 26% (17/65), respiratory failure 25% (16/65), and EtOH withdrawal 8% (5/65), Three patients had contraindications to tube feeds. Of the 62 included patients without contraindications to tube feeds, 85% (53/62) were started on tube feeds at any time and 61% (38/62) were started on tube feeds within 48 hours, and 15% (9/62) were not. Thirty of about ninety residents responded to the survey, of whom 77% (23/30) were “somewhat confident” starting tube feeds and only 13% (4/30) felt “confident in all aspects.” The reasons for not beginning enteral nutrition were lack of knowledge about correct formula 48% (14/30), timing of nutrition 45% (13/30), which patients require enteral nutrition 38% (11/30), and placing a nasogastric or orogastric tube 7% (2/30). CONCLUSIONS: Sixty-one percent of mechanically ventilated patients in our MICU were started on enteral feeds within 48 hours of intubation. Survey results from resident physicians suggest lack of knowledge and confidence as barriers to beginning enteral nutrition. Our survey was limited in sample size and in low survey response rate. CLINICAL IMPLICATIONS: This study demonstrates that many mechanically ventilated patients receive suboptimal enteral nutrition. In contrast to current literature, our study was limited to mechanically ventilated patients. Practitioner education and implementation of MICU nutrition protocol on admission would allow for improved guideline adherence and increase rates of enteral feeding. DISCLOSURES: No relevant relationships by Zein Kattih, source=Web Response no disclosure on file for linda kirschenbaum; No relevant relationships by Rebecca Mazurkiewicz, source=Web Response No relevant relationships by Rebecca Zweifler, source=Web Response

Bariatric Surgery Improves Renal Function: a Large Inner-City Population Outcome Study.

Bariatric surgery is associated with improved renal dysfunction in general population studies. The study examined the effects of bariatric surgery on renal function in a predominantly Hispanic and African American population at a community hospital in New York, USA. This retrospective study analyzed prospectively collected bariatric surgical data from 2247 patients (89% female) who underwent bariatric surgery at a single center. Changes in glomerular filtration rate (eGFR), urine albumin-creatinine ratio (UACR), micro- and macroalbuminuria, and hyperfiltration, which were measured preoperatively and then yearly for 3years postoperatively, were evaluated with t tests and logistic regression analysis, after adjusting for confounding variables. The mean age of the patients at surgery was 37.1years; the mean preoperative body mass index was 45 ± 7kg/m2. The results obtained 3years postoperatively showed the following significant improvements compared with the preoperative values: mean UACR decreased from 40.3 to 11.1mg/g, mean eGFR improved from 79.4 to 87.3mL/min, the prevalence of microalbuminuria decreased from 13.7 to 6.2%, the prevalence of macroalbuminuria decreased from 2.5 to 0%, and the prevalence of hyperfiltration decreased from 4.4 to 2.7% (all P < .0001). In adjusted multivariate regression analysis, these results remained significant after adjusting for age, sex, race, type of surgery, and presence of diabetes mellitus or hypertension. In this large study at an inner-city hospital, bariatric surgery was associated with significant improvements in renal dysfunction parameters. These results could assist with informed decisions regarding indications for bariatric surgery.

Improvement in glycated hemoglobin A1C after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in an ethnically diverse population with diabetes.

Obesity is a well-known risk factor for the development of type 2 diabetes. The efficacy of bariatric surgery in reducing weight with resulting improvement in type 2 diabetes has been reliably demonstrated. We investigated and compared the effects of laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) on glycated hemoglobin (HbA1C) levels in a predominantly Hispanic and black population. Community Hospital in New York, New York, United States. This is a retrospective review of a 5-year data from a single center where patients with diabetes who underwent LRYGB or LSG were included. HbA1C levels and body mass index were analyzed preoperatively and then annually postoperatively for up to 5 years. Improvements in HbA1C were compared between the 2 groups after adjusting for age, sex, race, and hypertension with linear mixed-effects or logistic regression models. Of the 676 included patients, 84.8% were females and the mean age was 47 years. HbA1C levels decreased significantly (P < .05) in the entire group at 1 (21%), 2 (20%), 3 (20%), 4 (18%), and 5 (14%) years. Compared with LSG, LRYGB patients displayed greater improvement in HbA1C levels at 1 year (25% versus 17%, P = .001). The differences in the reduction of HbA1C between LRYGB and LSG for the other time intervals were not significant (P > .05), 24% versus 17% (2 yr), 22% versus 16% (3 yr), 22% versus 13% (4 yr), and 17% versus 10% (5 yr). Changes in body mass index were not correlated to changes in HbA1C at various study points. Both LRYGB and LSG resulted in significant decreases in HbA1C levels and are correlated with changes in body mass index. LRYGB had the greatest effect at 1 year postoperatively. There was no significant difference in HbA1C reduction for LRYGB and LSG after 1 year postoperatively in this predominantly Hispanic and black cohort.

Clinical Characteristics and Predictors of Mortality in African Americans with COVID-19 from an Inner-City Community Hospital in New York

Background: There is limited data on the clinical presentation and predictors of mortality in the African-American (AA) patients hospitalized with COVID-19 despite the disproportionately higher burden and mortality. The aim of this study is to report on the clinical characteristics and the predictors of mortality in hospitalized AA patients with COVID-19 infection. Methods: In this retrospective cohort review, we included all AA patients with confirmed COVID-19 infection admitted to an inner-city teaching community hospital in New York City. Demographics, clinical presentation, baseline co-morbidities, and laboratory data were compared between survivors and non-survivors. The predictors of mortality were assessed using multivariate logistic regression analysis. Results: Of the 408 (median age, 67years) patients included, 276(66.65%, median age 63years) survived while 132(33.35%, median age 71years) died. The most common presenting symptoms were cough, myalgia, fever/chills, shortness of breath, and gastrointestinal symptoms (nausea, vomiting, diarrhea, and abdominal pain), with a prevalence of 62.50%, 43.87%, 53.68%, and 27.21%, respectively. Age (OR 1.06, CI 1.04-1.08, P-<0.001), body mass index (OR 1.07, CI 1.04-1.11, P-<0.001), elevated serum ferritin(OR 1.99, CI 1.08-3.66, P-0.02), C-reactive protein (OR 2.42, CI 1.36-4.33, P-0.01), and D-dimers(OR 3.79, CI 2.21-6.50, P-<0.001) at the time of presentation were identified as the independent predictors of mortality. Conclusions: Cough, shortness of breath, fever/chills, gastrointestinal symptoms, and myalgia were the predominant presentation among African-Americans hospitalized with COVID-19 infection. Advanced age, higher BMI, elevated ferritin, C-reactive protein, and D-dimers are independent predictors of mortality among hospitalized African-Americans with COVID-19 infection. Funding Statement: There was no funding for the study. Declaration of Interests: No conflict of interest for all the authors. Ethics Approval Statement: Ethical clearance was obtained from the hospital's IRB committee. Because our study was limited to chart review with no patient interactions, the requirement for informed consent was waived.

Management of Iron-Deficiency Anemia on Inpatients and Appropriate Discharge and Follow-Up.

BackgroundThe aims of the study were to identify appropriate supplementation of iron for inpatients and to identify factors involved in appropriate discharge documentation and follow-up.MethodsThis was a retrospective analysis of 103 patients at a community hospital in New York City.ResultsA total of 57 (57/103, 55.3%) patients were admitted due to symptomatic anemia. Twenty (20/103, 19.4%) of those with iron-deficiency anemia had either esophagogastroduodenoscopy or colonoscopy. Gastroenterologist or hematologist was consulted for 45/103 (43.7%). Inpatient iron supplementation was given for 62/103 (60.2%) of patients; and 43/103 (41.7%) had blood transfusion. Upon discharge, 50/103 (48.5%) had appropriate documentation of iron-deficiency anemia on discharge paperwork. Appropriate follow-up was done for 54/103 (52.4%). Iron supplementation was provided for 53/103 (51.5%) of patients. Having inpatient esophagogastroduodenoscopy or colonoscopy, blood transfusion, or symptomatic anemia had a statistical significance for likelihood of appropriate discharge documentation.ConclusionsIron-deficiency anemia can have high rates of mortality and morbidity in the population. Appropriate discharge of patients with iron-deficiency anemia and factors related to this are paramount for clinicians in order to have the best patient outcomes.

Comparison of disaster preparedness between Upstate and Downstate community hospitals in New York.

This study sought to determine whether differences exist in disaster preparedness between Upstate and Downstate community hospitals in New York. A descriptive and analytical cross-sectional survey study was conducted using a 35-element questionnaire. These questions examined six disaster preparedness components: disaster plan development, onsite surge capacity, available materials and resources, disaster education and training, disaster preparedness funding levels, and perception of disaster preparedness. The population surveyed included community hospitals across New York. Invitations to participate in the survey were emailed to the CEOs and disaster preparedness coordinators at 207 of the 208 community hospitals in New York. Eighty hospitals completed surveys, including 41 Upstate hospitals and 39 Downstate facilities. Responses to questions pertaining to the six disaster preparedness elements. There were differences in disaster preparedness between Upstate and Downstate hospitals with respect to disaster plan development, available materials and resources, and disaster education and training. No differences were identified in onsite surge capacity, disaster preparedness funding levels, or perception of disaster preparedness. The results demonstrate the current condition of disaster preparedness in Upstate and Downstate community hospitals in New York. Differences in preparedness between hospitals in the two locations may reflect factors such as availability of resources and differing priorities with regard to threat levels. They also suggest opportunities for improvement in disaster preparedness, which may require additional government resources and advocacy organization efforts.

Comparison of Disaster Preparedness Between Urban and Rural Community Hospitals in New York State.

The intent of this study was to determine whether there are differences in disaster preparedness between urban and rural community hospitals across New York State. Descriptive and analytical cross-sectional survey study of 207 community hospitals; thirty-five questions evaluated 6 disaster preparedness elements: disaster plan development, on-site surge capacity, available materials and resources, disaster education and training, disaster preparedness funding levels, and perception of disaster preparedness. Completed surveys were received from 48 urban hospitals and 32 rural hospitals.There were differences in disaster preparedness between urban and rural hospitals with respect to disaster plan development, on-site surge capacity, available materials and resources, disaster education and training, and perception of disaster preparedness. No difference was identified between these hospitals with respect to disaster preparedness funding levels. The results of this study provide an assessment of the current state of disaster preparedness in urban and rural community hospitals in New York. Differences in preparedness between the two settings may reflect differing priorities with respect to perceived threats, as well as opportunities for improvement that may require additional advocacy and legislation. (Disaster Med Public Health Preparedness. 2019;13:424-428).

Immediate Complications of Elective Newborn Circumcision.

To determine the incidence of immediate complications of elective newborn circumcision in 2 community teaching hospitals. We performed a retrospective chart review of all term neonates who had circumcision performed between August 2011 and December 2014 at 2 community hospitals in New York. Neonatal hospital records and subsequent inpatient and outpatient records were reviewed. We classified complications as minor, intermediate, and major. Out of a total of 1115 circumcisions, 1064 met inclusion criteria. There were 41 complications (3.9%), all involving hemorrhage. Sutures were used to control hemorrhage in 3 patients (0.3%). Local pressure or application of hemostatic chemical agents controlled bleeding in the remainder of patients. Bleeding was more common with the use of the Gomco clamp than with the Mogen clamp. Circumcisions performed with Gomco clamp represented 73.2% of the total complications compared with 26.8% with the Mogen clamp. There were no injuries to structures outside the prepuce or problems requiring medical treatment after discharge from the neonatal hospitalization. The most common immediate complication encountered during an elective neonatal circumcision was bleeding that required only pressure or topical thrombin to achieve hemostasis. Bleeding was more common with the use of the Gomco versus the Mogen clamp. To conclude, our data support the theory that elective infant circumcision can be performed safely in a hospital setting.

379 Sepsis Presenting in Emergency Department Versus Inpatient Settings: Divergences in Prevalence, Patient Characteristics, Initial Resuscitation, Outcomes, and Costs

Comparisons of community versus hospital presenting sepsis are surprisingly lacking. 1) Characterize baseline differences in emergency department (ED) versus inpatient (IP) presenting sepsis patients; 2) Compare ED versus IP presenting sepsis in 2 outcome domains: process outcomes and patient centered outcomes. 3) Estimate risk-differences for patient centered outcomes attributable to disparities in initial resuscitation. Design: Retrospective consecutive sample cohort. Setting: 9 Tertiary and Community Hospitals in New York over 1.5 years. Patients: All hospitalized patients with sepsis or septic shock, defined simultaneous 1) Infection AND 2) ≥2 SIRS criteria AND 3) ≥1 acute organ dysfunction criterion; with post-hoc confirmation. Exposure: ED versus IP presenting sepsis. ED sepsis defined as meeting all objective sepsis inclusion criteria while physically in the emergency department. IP sepsis defined as admitted patients meeting criteria after physically leaving the ED. Outcomes & Analysis: We assessed differences in baseline characteristics for IP versus ED sepsis with a generalized linear model using random effects to account for inter-hospital variability. We then generated a propensity-score for patient “location” when they presented with sepsis, and created a matched (PSM) cohort. We used doubly robust estimation in the PSM cohort to compare outcomes controlling for baseline differences. Process outcomes included 3h-bundle compliance and time to antibiotics. The primary patient outcome was hospital mortality. We calculated attributable risk to determine the proportion of patient outcome differences that were explained by resuscitation differences in groups. Of 11,182 sepsis hospitalizations, we classified 2,509 (22.4%) as IP and 8,673 (77.6%) as ED. Compared to ED sepsis, IP sepsis patients more often had heart failure (OR: 1.31, 95% CI: 1.18-1.47), renal failure (OR: 1.62, 1.38-1.91), or gastrointestinal infection (OR: 1.84, 1.48-2.29); more often presented with hypotension (OR: 1.85, 1.65-2.08), or impaired gas exchange (OR: 2.46, 1.43-4.24). IP sepsis less often were admitted from skilled nursing centers (OR: 0.44, 0.32-0.60), had COPD (OR: 0.53, 0.36-0.78), were febrile (OR: 0.64, 0.52-0.78) or tachypneic (OR: 0.76, 0.58-0.98), and presented with acute kidney injury (OR: 0.82, 0.68-0.97). In a cohort of 1,922 propensity matched pairs (n=3,844), IP sepsis patients had less than half the odds of receiving 3h-bundle compliant care (17.0% versus 30.3%, OR: 0.47, 0.40-0.57) or receiving antibiotics within 3-hrs (66.2% versus 83.8%, OR: 0.38, CI:0.32-0.44) versus. ED sepsis. IP sepsis was associated with higher mortality (31.2% versus 19.3%, OR:1.90, CI:1.64-2.20), but only 23.3% of this association was attributable to initial resuscitation differences (resuscitation adjusted OR:1.69, 1.43-2.00). Sepsis patients in the ED differed dramatically from IP sepsis by demographics, infection source, chronic and acute illness at presentation, and presenting signs. ED patients receive markedly more timely initial resuscitation, and have substantially better outcomes, but this disparity explains only a modest proportion of mortality differences. If and how these 2 populations should be conflated by treatment recommendations is unclear.

Epidemiology of Sepsis Among Adolescents at Community Hospital Emergency Departments

In 2012, Rory Staunton, a healthy 12-year-old boy, presented to the emergency department (ED) of a community hospital in New York with symptoms that, in retrospect, were determined to be caused by sepsis. He was seen, discharged, and subsequently died of septic shock. Consequently, the governor introduced Rory’s Regulations, which mandated that hospitals in New York implement protocols to recognize and treat sepsis according to evidence-based guidelines. These efforts may result in large public health benefits for patients. However, crucial to Rory’s case was that his diagnosis was missed. Efforts to avoid missed or delayed diagnosis are greatly enhanced by knowledge of the frequency and course of similar cases, yet such data are unknown. We therefore examined the electronic health records of healthy adolescents who presented to 12 community hospital EDs in southwestern Pennsylvania during the same period (January 1, 2010, through December 31, 2012) with signs and symptoms similar to those of Rory Staunton.

Perceptions of Structural Empowerment: Differences Between Nationally Certified Perinatal Nurses and Perinatal Nurses Who Are Not Nationally Certified

Although there has been previous research linking perceptions of empowerment to specialty certification among critical care nurses, no research in this area has been conducted among nationally certified perinatal nurses. A comparative quantitative survey design was used. Participants included 80 perinatal registered nurses from one community hospital in New York. Registered nurses who were nationally certified in a perinatal specialty had higher total empowerment scores and higher scores on five of the six subscales. This study supports the results of previous studies focused on differences in empowerment among nationally certified nurses and nurses without national certification. Because much of the preparation for certification is done within continuing education, nurse leaders must be cognizant of the value of certification and must develop and implement programs to support certification in the workplace.

Differences in Physical, Emotional, and Social Adjustment of Intimate, Family, and Nonfamily Patient-Partner Dyads Based on a Breast Cancer Intervention Study

To assess the degree to which postsurgical adjustment in patients with breast cancer and their partners depends on the nature of the patient-partner dyad relationship. Secondary data analysis from a randomized controlled trial. Three cancer centers and one suburban community hospital in New York. 205 patient-partner dyads (112 intimate-partner, 58 family-member, and 35 nonfamily-member dyads). Mann-Whitney nonparametric comparisons and chi-square tests were used to assess dyad types on continuous and categorical variables, and a mixed model for repeated measures compared postsurgical adjustment among dyad types. Type of patient-partner dyads and physical, emotional, and social adjustment. Patients in intimate-partner dyads were younger, had greater incomes, and discovered the lump by routine mammogram as compared to family- or nonfamily-member dyads. No significant differences were observed in patients' physical or emotional adjustment. Patients with intimate partners had greater difficulty in their social and domestic environments. Partners in intimate-partner dyads had lower scores on psychological well-being, more problems in social and domestic adjustment, and less social support to promote social adjustment. Women with breast cancer experience successful physical and emotional adjustment whether they have intimate-partner, family-member, or nonfamily-member partners. Intimate partners are at greater risk for emotional and social adjustment issues. When designing interventions, consideration must be given to the type of patient-partner dyad involved.

An Analysis of Referrals to Chaplains in a Community Hospital in New York over a Seven Year Period

The study analyzed the pattern of referrals to chaplains in a suburban hospital over a 7-year period. Nurses made more than half of all the referrals to chaplains, with nursing accounting for 81.74% of referrals from staff members other than pastoral care workers and volunteers. Social workers and physicians made 11.74% and 4.08% of referrals, respectively. The number of referrals from social workers (r=.86, p<.05), nurses (r=.68, p<.10) and other staff (r=.69, p<.10) increased across years, with the exception of physicians. Three quarters of referrals were requests for chaplains to visit patients and one quarter were requests to visit with family or friends. A significant difference was found in the percentage of referrals made for patients and family/friends by staff members (p<.05), with social workers making a higher percentage of referrals for relatives and friends (34.1%), compared to nurses (26.74%) and physicians (27.27%). The most common presenting problems for which patients were referred to chaplains were anxiety, depression, and pregnancy loss. The rate of referrals for patients over the entire study period was 39.04 per 1000 patient stays.

Sucrose and commercially available milk reduced crying in newborns during a blood collection procedure

Blass EM. Milk-induced hypoalgesia in human newborns. Pediatrics 1997 Jun; 99 : 825 –9. [OpenUrl][1][Abstract/FREE Full Text][2] To determine the effectiveness of milk and its components for reducing crying in...

Attitudes Toward the Care of Patients With Acquired Immunodeficiency Syndrome

Community physicians may play an increasing role in treating patients with acquired immunodeficiency syndrome (AIDS) because of the shift away from inpatient care. At a community hospital in New York, NY, we surveyed 230 attending physicians in a department of medicine to determine their attitudes toward the care of patients with AIDS. Factor analysis produced three clusters of attitudes termed antipathy, liability, and isolation. These factors, together with physicians' "knowledge" and background, were analyzed as predictors of treating patients with AIDS. While antipathy, isolation, and fear of acquiring AIDS were not predictors, liability scores were inversely correlated with the likelihood of treating the disease (r = -.18). Liability was influenced by patients' attitudes toward AIDS. Primary care physicians had higher liability and isolation scores than subspecialists and were more likely to see support groups, guaranteed funding, and education as incentives to treat patients with AIDS. Further study is needed to target measures that support primary care physicians in their care of patients with this disease.