Using the information system to assess change: the impact of downsizing the acute sector.

A population-based approach was used to monitor impact of hospital bed closures in Winnipeg, Manitoba. Four years of administrative data were analyzed. Access to hospital services was not adversely affected: The reduction in beds resulted in increases in outpatient surgery and earlier discharges. In addition, access favored the admission of persons with more health care needs. Quality of care, as measured by mortality within 3 months of admission, readmission rates within 30 days of discharge, and increased contact with physicians within 30 days of discharge, did not change. The health status of the Winnipeg population, measured by premature mortality, did not change. However, health status and hospital use was found to be strongly related to socioeconomic status. In light of this gradient, the authors conclude that well designed and evaluated experiments that focus on the determinants of health, rather than on providing more health care services, could help identify ways of reducing hospital use.