title: Quality of medical care during and shortly after acute care restructuring in Newfoundland and Labrador.
abstract: OBJECTIVE
  To critically evaluate the quality of hospital medical care at the beginning, during and shortly after regionalization of health boards in Newfoundland and Labrador, and aggregation of hospitals in the St John's region.
  
  
  METHODS
  Retrospective chart audits for the years 1995/96, 1998/99 and 2000/01 (at the beginning, during and after restructuring) focused on outcomes in cardiology, respiratory medicine, neurology, nephrology, psychiatry, surgery and women's health programmes. Where possible, quality of care was judged on measurable outcomes in relation to published statements of likely optimal care. Comparisons were made over time within the St John's region, and separately for hospitals in the rest of the province.
  
  
  RESULTS
  There was improvement in the use of thrombolytics and secondary measures post-myocardial infarction in both regions. Mortality and appropriateness of initial antibiotic choice for community-acquired pneumonia remained stable in both regions, with an improvement in admission appropriateness based on the severity in St John's. Aspects of stroke management (referral and time to see allied health professionals, imaging and discharge home) improved in both regions, while mortality remained stable. There was improvement in fistula rate, quality of dialysis and anaemia management in haemodialysis patients, and improvement in the peritoneal dialysis patient peritonitis rate. Readmission rate for schizophrenia remained unchanged. Stable mortality rates were observed for frequently performed surgical procedures. The post-coronary artery bypass grafting (CABG) morbid event rate improved, although access to CABG was not optimal.
  
  
  CONCLUSIONS
  Aggregation of acute care hospitals was feasible without attendant deterioration in patient care, and in some areas care improved. However, access to services continued to be a major problem in all regions.
authors.affiliation: Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada.
authors.forename: Bryan
authors.initials: B
authors.lastname: Curtis
authors.forename: Deborah
authors.initials: D
authors.lastname: Gregory
authors.forename: Patrick
authors.initials: P
authors.lastname: Parfrey
authors.forename: Gloria
authors.initials: G
authors.lastname: Kent
authors.forename: Susan
authors.initials: S
authors.lastname: Jelinski
authors.forename: Scott
authors.initials: S
authors.lastname: Kraft
authors.forename: Daria
authors.initials: D
authors.lastname: O'Reilly
authors.forename: Brendan
authors.initials: B
authors.lastname: Barrett
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D018166:Health Care Reform; D017052:Hospital Mortality; D006752:Hospital Planning; D006754:Hospital Restructuring; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009523:Newfoundland and Labrador; D011787:Quality of Health Care / Q000639:trends*; D012040:Regional Health Planning / Q000458:organization & administration*; D012189:Retrospective Studies; D014600:Utilization Review