monitoring the impact of hospital bed closures in winnipeg, manitoba
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MANITOBA CENTRE FOR HEALTH POLICY & EVALUATION. Monitoring the Impact Of Hospital Bed Closures in Winnipeg, Manitoba. PRINCIPAL AUTHOR MARNI D. BROWNELL March, 1999. - PowerPoint PPT PresentationTRANSCRIPT
Monitoring the ImpactOf Hospital Bed Closuresin Winnipeg, Manitoba
MANITOBA CENTRE FOR HEALTH POLICY & EVALUATION
PRINCIPAL AUTHORMARNI D. BROWNELLMarch, 1999
Between 1991 and 1997, 727 (or 24%) of acute care beds closed in Winnipeg hospitals. The largest cuts came in 1992 and 1993 when 515 (over 17%) acute care beds were removed from the system.
What has been the impact of bed closures? Three broad areas were examined:• access to care• quality of care• health of the population
Access to Winnipeg hospital services, by Winnipeg and non-Winnipeg residents, has not been adversely affected: just as many patients were cared for in 1997 as before bed closures, with fewer resources.
Access to Care
Access: Hospitalizationsper 1000 Winnipeggers
0
20
40
60
80
100
120
140
160
1989 1990 1991 1992 1993 1994 1995 1996 1997
Outpatient Surgery Short Stays < 60 days Acute Hosp. 60+ days
There has been a shift in the way care is delivered.The number of days patients spent in Winnipeg hospitals dropped dramatically: days in acute hospitals per 1000 Winnipeggers fell by over 25% between 1991 and 1997.
Shifts in Delivery of Care
Changing Use: Hospital Days Changing Use: Hospital Days per 1000 Winnipeggersper 1000 Winnipeggers
0
200
400
600
800
1000
1200
1400
1989 1990 1991 1992 1993 1994 1995 1996 1997Short Stays < 60 days Acute Hosp. 60+ days
The number of Winnipeg residents treated for medical conditions in Winnipeg hospitals declined by almost 6% between 1991 and 1997.
Shifts in Delivery of Care
For those medical patients who were the sickest or required the most complex levels of care, there were no changes in the rate of hospital use.
Shifts in Delivery of Care
Adult Hospital Cases per 1000 Winnipeg Residents
0
5
10
15
2025
30
35
40
45
InpatientSurgery
OutpatientSurgery
Medical Obstetrics Psychiatry
1989 1990 1991 1992 1993 1994 1995 1996 1997
There has been a drop in paediatric use of hospital, but it seems unrelated to bed closings. The drop coincides with new clinical guidelines which encourage keeping children out of hospital.
Shifts in Delivery of Care
Bed closures have not lead to a rationing of surgical care; access to certain high profile procedures increased dramatically between 1991 and 1997. For example, knee surgery increased by 169%.
Shifts in Delivery of Care
Total Adult Hospital Procedures per Year
0
100200
300400
500
600
700
800900
1000
Bypass Angioplasty Total Hip Knee Replace1990 1991 1992 1993 1994 1995 1996 1997
0
1000
2000
3000
4000
5000
6000
7000
Cataracts1990 1991 1992 1993 1994 1995 1996 1997
Total Adult Hospital Procedures per Year
Between 1991 and 1997, there has been no increase in deaths, visits to emergency rooms or visits to physicians’ offices following discharge from hospital.
Quality of Care
For 12 of the 13 categories studied, readmissions rates in 1997 did not differ from rates prior to bed closures. The readmission rate for digestive disorders did rise, and needs further study.
Quality of Care
Readmission RatesWithin 30 Days of Discharge
0
2
4
6
8
10
12
14
16
18
1989 1990 1991 1992 1993 1994 1995 1996 1997
NormalNewbornsVaginal
Deliveries
A.M.I. Digestive Disorders Simple
Pneumonia
HeartFailure /Shock
Bronchitis /Asthma
%
Surgical Readmission RatesWithin 30 Days of Discharge
0
2
4
6
8
10
12
1989 1990 1991 1992 1993 1994 1995 1996 1997
Inguinal/FemoralHernia
Caesarean Section
Prostate Uterine/Adnexal
Anal/Stomal
Major Bowel
%
When all Winnipeg residents were looked at as one group, the population mortality rates did not change between 1991 and 1996.
Health of the Population
When groups were studied separately, we found that for those from the poorest neighbourhoods, premature mortality rates (deaths for those up to 74 years of age) had increased;...
Health of the Population
…yet, this is a group whose use of hospital services has remained the same. So bed closures seem unrelated to this increase.
Health of the Population
Marked inequalities in health by socioeconomic group remain. In 1996, the premature mortality rate for those from the middle income group was 60% higher than for those from the wealthiest group;...
Health of the Population
... for those from the lowest income group the premature mortality rate was 154% higher than for those from the wealthiest group.
Health of the Population
Mortality Rates: Grouped byNeighbourhood Income Quintile
0
1
2
3
4
5
6
Aged 0-74Q1 - Poorest Q2 Q3 Q4 Q5 - Wealthiest
DEATHS PER 1000 WINNIPEGGERS
Patient access to hospital services, in terms of the numbers of patients treated, did not change during the period of downsizing, however, the mix of patients and the location of treatment has changed.
Conclusions
The number of days patients spend in hospital has decreased dramatically.Access to high profile surgical procedures has increased dramatically.
Conclusions
For the most part, quality of care, as measured by mortality rates, readmission rates and visits to physicians, remained unchanged.
Conclusions
Overall, the health of Winnipeg residents didn’t change. However, the health of the poor worsened.
Conclusions
ManitobaCentre forHealth Policy &Evaluation
DESIGN BY RJ CURRIE
MCHPE