1. Monitoring the Impact Of Hospital Bed Closures in Winnipeg, Manitoba MANITOBA CENTRE FOR HEALTH POLICY & EVALUATION PRINCIPAL AUTHOR MARNI D. BROWNELL March, 1999

2. 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.

3. What has been the impact of bed closures? Three broad areas were examined: access to care quality of care health of the population

4. 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

5. Access: Hospitalizations per 1000 Winnipeggers

6. 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

7. Changing Use: Hospital Days per 1000 Winnipeggers

8. The rate of inpatient surgery dropped by over 31% between 1991 and 1997, while at the same time the rate of outpatient surgery increased by almost 43%. Overall, surgery increased by almost 5%. Shifts in Delivery of Care

9. 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

10. 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

11. Adult Hospital Cases per 1000 Winnipeg Residents

12. 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

13. 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

14. Total Adult Hospital Procedures per Year

16. 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

17. 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

18. Readmission Rates Within 30 Days of Discharge Normal Newborns Vaginal Deliveries A.M.I. Digestive Disorders Simple Pneumonia Heart Failure / Shock Bronchitis / Asthma %

19. Surgical Readmission Rates Within 30 Days of Discharge Inguinal/ Femoral Hernia Caesarean Section ProstateUterine/ Adnexal Anal/ Stomal Major Bowel %

20. 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

21. 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

22. …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

23. 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

24. ... 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

25. Mortality Rates: Grouped by Neighbourhood Income Quintile DEATHS PER 1000 WINNIPEGGERS

26. 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

27. The number of days patients spend in hospital has decreased dramatically. Access to high profile surgical procedures has increased dramatically. Conclusions

28. For the most part, quality of care, as measured by mortality rates, readmission rates and visits to physicians, remained unchanged. Conclusions

29. Overall, the health of Winnipeg residents didn’t change. However, the health of the poor worsened. Conclusions

30. M anitoba C entre for H ealth P olicy & E valuation DESIGN BY RJ CURRIE M C H P E