The impact of hospital closures and health service restructuring on provincial- and community-level patterns of hospital admissions​

1. The impact of hospital closures and
health service restructuring on provincial-
and community-level patterns of hospital
admissions
Dan L Crouse
Research Associate

2. Background
Due to aging rural populations, escalating
health care costs, & increasing demand for
services in urban areas, most provinces have
tried reorganizing health care services to:
• reduce costs
• improve access
• improve outcomes

3. Background
• Few Canadian studies on the impacts on
access, use, or health status
• Results have been inconsistent.
• Difficult to generalize findings

4. NB Context
Reforms to contain rising expenditures by
centralizing acute care services in larger
population centres and
closing/repurposing 8 rural hospitals
mid 2000s
30 general/acute facilities
2004
22 still active
2013
~ 300 hospital beds phased out

5. Objective
Whether changes in geographic access to hospitals following the
restructuring were associated with changes in patterns of
selected indicators of hospital access and use, overall, and at the
local, community scale.

6. Ambulatory Care Sensitive
Conditions (ACSCs)
angina; asthma; chronic
obstructive pulmonary
disorder; congestive heart
failure and pulmonary
edema; diabetes; grand
mal status and other
epileptic convulsions; and
hypertension.
adults <75 years of age

7. Specific outcomes
Age-standardized, per 1,000 population, 2004 through 2013:
1. annual hospitalization rates for ACSCs
2. annual incidences of hospital admission for ACSCs
3. annual rates of hospital admission for ACSCs via ambulance

8. Health Council Communities
• 33 communities, developed by the NB Health Council
• Based on health zones, health care service catchment areas,
and Statistics Canada’s census subdivisions
• Each has a minimum population of 5,000 people
• 4 peer groupings

10. Data
NB hospital Discharge
Abstract Database
administrative, clinical, and
demographic information, including
data on hospital discharges, deaths,
sign-outs, and transfers
Citizen Database
demographic and location info

11. Results…

12. 0
2
4
6
8
10
12
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Age-standardized
rate
per
1,000
New Brunswick - Hospitalization rate New Brunswick - Hospitalization incidence New Brunswick - Ambulance arrival rate

13. 0
2
4
6
8
10
12
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Age-standardized
rates
per
1,000
Peer Group A Peer Group B Peer Group C Peer Group D
Hospitalization Rates

14. Changes in ambulance
arrival rates
(2004-2013)

15. Decreases in hospitalization incidence rates
(2004-2013)
Decreases in hospitalization rates
(2004-2013)

16. Results – Florenceville-Bristol rates
0
2
4
6
8
10
12
14
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Age-standardized
rates
per
1,000
Hospitalization rate
Hospitalization incidence
Ambulance arrival rate
Two small hospitals closed, 1 new, larger hospital opened

17. Results – Caraquet rates
0
2
4
6
8
10
12
14
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Age-standardized
rates
per
1,000
Hospitalization rate
Hospitalization incidence
Ambulance arrival rate
Smaller hospital repurposed as a Community Health Centre

18. Interpretation
Replacing acute care services with more primary care
appears to have been effective; i.e., individuals with
ambulatory care sensitive conditions are being treated
successfully within their communities

19. Strengths
Longitudinal study design
Multiple geographic scales and peer groups
Several indicators of service use
Recognized markers of efficient/effective primary care

20. Limitations
Didn’t control for possible secular trends in health status
Considered only selected outcomes
Only adults 25-75
Limited to outcomes measurable with administrative data

21. Key message
Changes to hospital service provision implemented in the early
2000s had little effect on rates of ACSC hospital service use

22. Thank you
Team: Kyle Rogers & Ted McDonald