A case study of hospital closure and centralization of coronary revascularization procedures

Background: Despite nation-wide efforts to reduce health care costs through hospital closures and centralization of services, little is known about th e impact of such actions. We conducted this study to determine the effect o f a hospital closure in Calgary and the resultant centralization of coronar y revascularization procedures from 2 facilities to a single location. Methods: Administrative data were used to identify patients who underwent c oronary artery bypass grafting (CABG), including those who had combined CAB G and valve procedures, and patients who underwent percutaneous translumina l angioplasty (PTCA) in the Calgary Regional Health Authority from July 199 4 to March 1998. This period represents the 21 months preceding and the 24 months following the March 1996 hospital closure. Measures, including mean number of discharges, length of hospital stay, burden of comorbidity and in hospital death rates, were compared before and after the hospital closure f or CABG and PTCA patients. Multivariate analyses were used to derive risk-a djustment models to control for sociodemographic variables and comorbidity. Results: The number of patients undergoing CABG was higher in the year foll owing than in the year preceding the hospital closure (51.6 per 100 000 bef ore v. 67.3 per 100 000 after the closure); the same was true for the numbe r of patients undergoing PTCA (129.8 v. 143.6 per 100 000). The burden of c omorbidity was significantly higher after than before the closure, both for CABG patients (comorbidity index 1.3 before v. 1.5 after closure, p < 0.00 1) 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 we re slightly lower after than before the closure in the CABG group. The adju sted rates of death or CABG in the PTCA group did not differ significantly between the 2 periods. Interpretation: Hospital closure and the centralization of coronary revascu larization procedures in Calgary was associated with increased population r ates of procedures being performed, on sicker patients, with shorter hospit al stays, and, for CABG patients, a trend toward more favourable short-term outcomes. Our findings indicate that controversial changes to the structur e of the health care system can occur without loss of efficiency and reduct ion in quality of care.