title: Effect of Hospital Closures on Acute Care Outcomes in British Columbia, Canada: An Interrupted Time Series Study.
abstract: BACKGROUND
  In 2002 British Columbia, Canada began redistributing its hospital services.
  
  
  OBJECTIVE
  We used administrative data and interrupted time series analyses to determine how recent hospital closures affected patient outcomes.
  
  
  METHODS
  All adult acute myocardial infarction (AMI), stroke, and trauma events in British Columbia between fiscal years 1999 and 2013. Cases were patients whose closest hospital closed. Controls were matched by condition, year of event, and condition-specific hospital volume where treatment was received.
  
  
  METHODS
  Thirty-day mortality and hospital bypass rates.
  
  
  RESULTS
  We matched 3267 AMI, 2852 stroke, and 6318 trauma cases to 1996, 1604, and 3640 controls, respectively. The 30-day mortality rate at baseline was 7.0% [95% confidence interval (CI), 4.0%-10.1%] for AMI, 5.3% (95% CI, 2.4%-8.1%) for stroke, and 1.2% (95% CI, 0.3%-2.1%) for trauma controls. The 30-day mortality rate for cases was 14.3% (95% CI, 7.1%-21.7%) for AMI, 12.0% (95% CI, 5.1%-18.9%) for stroke, and 3.1% for trauma (95% CI, 0.9%-5.2%) cases. There was no significant change in 30-day mortality for cases, and no significant difference in change in mortality rates between cases and controls following the intervention. The difference in hospital bypass rates between cases and controls was 50.1% (95% CI, 42.3%-57.9%) for AMI, 36.2% (95% CI, 27.4%-44.9%) for stroke, and 32.2% (95% CI, 27.7%-36.8%) for trauma cases preintervention. Following the intervention, the difference in bypass rates dropped by 15.5% (95% CI, 3.5%-27.5%) for AMI, 25.3% (95% CI, 11.7%-38.8%) for stroke, and 22.7% (95% CI, 15.7%-29.6%) for trauma cases.
  
  
  CONCLUSIONS
  Hospital closures did not affect patient mortality.
authors.affiliation: UBC Centre for Health Services and Policy Research, The University of British Columbia, Vancouver, BC, Canada.
authors.forename: Dimitra
authors.initials: D
authors.lastname: Panagiotoglou
authors.forename: Michael R
authors.initials: MR
authors.lastname: Law
authors.forename: Kimberlyn
authors.initials: K
authors.lastname: McGrail
mesh_terms: D000328:Adult; D000368:Aged; D001955:British Columbia; D016022:Case-Control Studies; D005260:Female; D005843:Geography; D006271:Health Facility Closure / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D065186:Interrupted Time Series Analysis; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D017063:Outcome Assessment, Health Care; D020521:Stroke / Q000401:mortality*; D061665:Time-to-Treatment; D014947:Wounds and Injuries / Q000401:mortality*