Do hospital bed reduction and multiple system reform affect patient mortality? A trend and multilevel analysis in New Zealand over the period 1988-2001

Show simple item record Davis, Peter en Lay Yee, Roy en Scott, Alastair en Gauld, D en 2012-03-27T00:20:05Z en 2015-09-02T03:51:32Z en 2007 en
dc.identifier.citation Medical Care, 2007, 45 pp. 1186 - 1194 (9) en
dc.identifier.issn 0025-7079 en
dc.identifier.uri en
dc.description.abstract Background: The impact of hospital and system restructuring on the quality and pattern of care is an important issue of public policy concern. Objective: To assess the effect on patterns of care and patient outcomes of a substantial reduction in public hospital bed availability and multiple reorganizations in New Zealand through the 1990s. Research Design: Trend analysis using both tabular and multilevel techniques. Subjects: Access to discharge data, amounting to 6,639,487 records, was secured for all 34 major public hospitals in New Zealand over the period 1988 –2001. Outcome Measures: Number of discharges, admission rate, access levels, mean length of stay, unplanned readmission rate, and 60-day postadmission mortality rate. Results: Although the number of inpatient beds in use declined by one-third over the period and the national population grew by nearly one-fifth, discharge volumes increased significantly and rates of inpatient admission were maintained, as were access levels for vulnerable groups. These changes were accompanied by workload adjustments (a halving in length of stay and an increase by a quarter in readmission rates). Yet age-adjusted postadmission patient mortality decreased by a quarter over the period of study, a rate of decline that was slowed by the major workload adjustments but not by reform phase. Conclusions: Other things being equal, a substantial reduction in inpatient bed availability can be effected in national public hospital systems, while largely maintaining access and quality of care. However, the workload adjustments that are required may slow improvements in patient outcomes. en
dc.publisher Lippincott, Williams & Wilkins en
dc.relation.ispartofseries Medical Care en
dc.relation.replaces en
dc.relation.replaces 2292/15532 en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. Details obtained from en
dc.rights.uri en
dc.title Do hospital bed reduction and multiple system reform affect patient mortality? A trend and multilevel analysis in New Zealand over the period 1988-2001 en
dc.type Journal Article en
dc.identifier.doi 10.1097/MLR.0b013e3181468c92 en
pubs.begin-page 1186 en
pubs.volume 45 en
dc.rights.holder Copyright: Lippincott, Williams & Wilkins en
dc.identifier.pmid 18007169 en
pubs.end-page 1194 en
dc.rights.accessrights en
pubs.subtype Article en
pubs.elements-id 77131 en Arts en Arts Research en Compass en
pubs.record-created-at-source-date 2010-09-01 en
pubs.dimensions-id 18007169 en

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