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Effect of Hospital Closures on Acute Care Outcomes in British Columbia, Canada: An Interrupted Time Series Study

Panagiotoglou, Dimitra MPH; Law, Michael R. PhD; McGrail, Kimberlyn PhD

doi: 10.1097/MLR.0000000000000619
Original Articles

Background: In 2002 British Columbia, Canada began redistributing its hospital services.

Objective and Design: We used administrative data and interrupted time series analyses to determine how recent hospital closures affected patient outcomes.

Subjects: All adult acute myocardial infarction (AMI), stroke, and trauma events in British Columbia between fiscal years 1999 and 2013. Cases were patients whose closest hospital closed. Controls were matched by condition, year of event, and condition-specific hospital volume where treatment was received.

Measures: Thirty-day mortality and hospital bypass rates.

Results: We matched 3267 AMI, 2852 stroke, and 6318 trauma cases to 1996, 1604, and 3640 controls, respectively. The 30-day mortality rate at baseline was 7.0% [95% confidence interval (CI), 4.0%–10.1%] for AMI, 5.3% (95% CI, 2.4%–8.1%) for stroke, and 1.2% (95% CI, 0.3%–2.1%) for trauma controls. The 30-day mortality rate for cases was 14.3% (95% CI, 7.1%–21.7%) for AMI, 12.0% (95% CI, 5.1%–18.9%) for stroke, and 3.1% for trauma (95% CI, 0.9%–5.2%) cases. There was no significant change in 30-day mortality for cases, and no significant difference in change in mortality rates between cases and controls following the intervention. The difference in hospital bypass rates between cases and controls was 50.1% (95% CI, 42.3%–57.9%) for AMI, 36.2% (95% CI, 27.4%–44.9%) for stroke, and 32.2% (95% CI, 27.7%–36.8%) for trauma cases preintervention. Following the intervention, the difference in bypass rates dropped by 15.5% (95% CI, 3.5%–27.5%) for AMI, 25.3% (95% CI, 11.7%–38.8%) for stroke, and 22.7% (95% CI, 15.7%–29.6%) for trauma cases.

Conclusions: Hospital closures did not affect patient mortality.

UBC Centre for Health Services and Policy Research, The University of British Columbia, Vancouver, BC, Canada

This research was funded by 2 CIHR Strategic Training Program Awards provided by the Western Regional Training Centre and Public Health and the Agricultural Rural Ecosystem (PHARE); and Partner Institutes including the Institute of Health Services and Policy Research, Institute of Circulatory and Respiratory Health, Institute of Infection and Immunity, and the Institute of Population and Public Health.

This data was recently presented at the CHSPR 2016 conference in Vancouver, British Columbia (April 5–6, 2016).

All inferences, opinions, and conclusions drawn in this publication are those of the authors and do not reflect the opinions or policies of the Data Stewards.

The authors declare no conflict of interest.

Reprints: Dimitra Panagiotoglou, MPH, UBC Centre for Health Services and Policy Research, The University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3. E-mail:

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