Do Hospital Bed Reduction and Multiple System Reform Affect Patient Mortality?
Bibliographic record
Abstract
BACKGROUND: The impact of hospital and system restructuring on the quality and pattern of care is an important issue of public policy concern. OBJECTIVE: To assess the effect on patterns of care and patient outcomes of a substantial reduction in public hospital bed availability and multiple reorganizations in New Zealand through the 1990s. RESEARCH DESIGN: Trend analysis using both tabular and multilevel techniques. SUBJECTS: Access to discharge data, amounting to 6,639,487 records, was secured for all 34 major public hospitals in New Zealand over the period 1988-2001. OUTCOME MEASURES: Number of discharges, admission rate, access levels, mean length of stay, unplanned readmission rate, and 60-day postadmission mortality rate. RESULTS: Although the number of inpatient beds in use declined by one-third over the period and the national population grew by nearly one-fifth, discharge volumes increased significantly and rates of inpatient admission were maintained, as were access levels for vulnerable groups. These changes were accompanied by workload adjustments (a halving in length of stay and an increase by a quarter in readmission rates). Yet age-adjusted postadmission patient mortality decreased by a quarter over the period of study, a rate of decline that was slowed by the major workload adjustments but not by reform phase. CONCLUSIONS: Other things being equal, a substantial reduction in inpatient bed availability can be effected in national public hospital systems, while largely maintaining access and quality of care. However, the workload adjustments that are required may slow improvements in patient outcomes.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".