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Titolo:
A case study of hospital closure and centralization of coronary revascularization procedures
Autore:
Hemmelgarn, BR; Ghali, WA; Quan, H;
Indirizzi:
Univ Calgary, Dept Med, Calgary, AB T2N 4N1, Canada Univ Calgary Calgary AB Canada T2N 4N1 t Med, Calgary, AB T2N 4N1, Canada Univ Calgary, Dept Community Hlth Sci, Calgary, AB T2N 4N1, Canada Univ Calgary Calgary AB Canada T2N 4N1 h Sci, Calgary, AB T2N 4N1, Canada
Titolo Testata:
CANADIAN MEDICAL ASSOCIATION JOURNAL
fascicolo: 10, volume: 164, anno: 2001,
pagine: 1431 - 1435
SICI:
0820-3946(20010515)164:10<1431:ACSOHC>2.0.ZU;2-Z
Fonte:
ISI
Lingua:
ENG
Soggetto:
NEW-YORK-STATE; ANGIOPLASTY PROCEDURES; BYPASS-SURGERY; VOLUME; MORTALITY; OUTCOMES; CARE; ACCESS; CANADA;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
22
Recensione:
Indirizzi per estratti:
Indirizzo: Ghali, WA Univ Alberta, Hlth Sci Ctr, 3330 Hosp Dr NW, Calgary, AB T2N 4N1, Canada Univ Alberta 3330 Hosp Dr NW Calgary AB Canada T2N 4N1 1, Canada
Citazione:
B.R. Hemmelgarn et al., "A case study of hospital closure and centralization of coronary revascularization procedures", CAN MED A J, 164(10), 2001, pp. 1431-1435

Abstract

Background: Despite nation-wide efforts to reduce health care costs through hospital closures and centralization of services, little is known about the impact of such actions. We conducted this study to determine the effect of a hospital closure in Calgary and the resultant centralization of coronary revascularization procedures from 2 facilities to a single location. Methods: Administrative data were used to identify patients who underwent coronary artery bypass grafting (CABG), including those who had combined CABG and valve procedures, and patients who underwent percutaneous transluminal angioplasty (PTCA) in the Calgary Regional Health Authority from July 1994 to March 1998. This period represents the 21 months preceding and the 24months following the March 1996 hospital closure. Measures, including meannumber of discharges, length of hospital stay, burden of comorbidity and inhospital death rates, were compared before and after the hospital closure for CABG and PTCA patients. Multivariate analyses were used to derive risk-adjustment models to control for sociodemographic variables and comorbidity. Results: The number of patients undergoing CABG was higher in the year following than in the year preceding the hospital closure (51.6 per 100 000 before v. 67.3 per 100 000 after the closure); the same was true for the number of patients undergoing PTCA (129.8 v. 143.6 per 100 000). The burden of comorbidity was significantly higher after than before the closure, both for CABG patients (comorbidity index 1.3 before v. 1.5 after closure, p < 0.001) and for PTCA patients (comorbidity index 1.0 before v. 1.1 after, p = 0.04). After adjustment for comorbidity, the mean length of hospital stay was significantly lower after than before the closure for CABG patients (by 1.3 days) and for PTCA patients (by 1.0 days). The adjusted rates of death were slightly lower after than before the closure in the CABG group. The adjusted rates of death or CABG in the PTCA group did not differ significantlybetween the 2 periods. Interpretation: Hospital closure and the centralization of coronary revascularization procedures in Calgary was associated with increased population rates of procedures being performed, on sicker patients, with shorter hospital stays, and, for CABG patients, a trend toward more favourable short-term outcomes. Our findings indicate that controversial changes to the structure of the health care system can occur without loss of efficiency and reduction in quality of care.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 22/01/20 alle ore 06:55:50