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The quick and the dead: "managing" inpatient care in British Columbia hospitals, 1969-1995/96
K M McGrail1, R G Evans, M L Barer
1Centre for Health Services and Policy Research, The University of British Columbia, Vancouver, Canada.
Insights
Hospital capacity reductions in British Columbia led to decreased acute and extended care use. Care for the dying increased, while the "bed blocker" issue diminished, though patient care location remains unclear.
Area of Science:
- Health Services Research
- Hospital Management
- Public Health Policy
Background:
- British Columbia experienced a decade of hospital capacity reductions.
- Understanding the impact on hospital service utilization is crucial.
Purpose of the Study:
- To examine changes in hospital use in British Columbia during a period of capacity reductions.
- To analyze trends in acute care, rehabilitation, extended care, and surgical day care.
Main Methods:
- Analysis of all hospital separation records from 1969 to 1995/96.
- Per capita use of services examined for five-year age groups up to 90+.
- Focus on changes over 26 years, particularly the last decade.
Main Results:
- Acute care use declined, with an accelerated rate in the last study period, affecting all age groups.
- Extended care use decreased, contrasting with earlier steady increases.
- By 1995/96, nearly 40% of inpatient days were for patients who died in hospital, up from 9% in 1969.
Conclusions:
- The
- bed blocker
- problem appears alleviated due to capacity reductions.
- Decreased extended care use raises questions about patient care location.
- Increased hospital care for the dying is noted, but the cause (e.g., end-of-life interventions) is unclear.
Objective:
To examine changes in hospital use in British Columbia during a decade of capacity reductions.
Data Sources/Study Setting:
The data used are all separation records for British Columbia hospitals for the years 1969, 1978, 1985/86, 1993/94, and 1995/96. Separation records include acute care, rehabilitation, extended care, and surgical day care hospital encounters in British Columbia that were concluded during the years of interest.
Study Design:
Analyses were based on per capita use of services for five-year age groups of the population to ages 90+; the emphasis was on looking at changes in the use of specific types of hospital services over the 26 years of study, with a particular focus on the most recent decade.
Data Collection/Extraction Methods:
Data were extracted from hospital separations files owned by the British Columbia Ministry of Health and housed at the Centre for Health Services and Policy Research. All separation records for the years of interest were included in the study.
Principal Findings:
Acute care use continued to fall over the last decade. The rate of decline increased during the last time period of study and affected seniors to the same degree as younger patients. At the same time, use of extended care decreased, compared to steady increases in earlier years. The result was that by 1995/96 nearly 40 percent of inpatient days were used by people who died in hospital, compared to 9 percent in 1969. These people, however, still represent a small proportion of separations.
Conclusions:
The "bed blocker" problem common to many hospital systems appears to have been largely alleviated in British Columbia over the decade 1985-95. The concurrent decrease in extended care use, however, makes it difficult to say where and how these people are now being cared for. Care for the dying has become a bigger issue for hospitals, but whether this is because of heroic interventions at the end of life is not clear. A "top-down," capacity-driven management approach to hospital use in British Columbia has produced effects that may seem familiar to those involved in more "bottom-up" managed care approaches in the United States.
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