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UBC Theses and Dissertations

The impact of hospital medical day care on inpatient use Romilly, Lorna Marie


The impact of the introduction of hospital medical day care programs on inpatient use was studied, to see if there was a reduction in average lengths of stay, cases or patient days, for those diagnostic categories in the programs. The provincial government funded these programs to create an alternative to hospitalization. Studies on the issue of whether or not day care is an alternative or substitutes for inpatient use were examined. Interest in ambulatory care is growing because of the increasing age of the population, increasing duration of chronic illness and increasing costs of hospital services. Three programs at Lions Gate Hospital in North Vancouver, B.C. were chosen: Chronic Obstructive Lung Disease (CO.L.D.) program, Diabetic Day Care,and the Neuro (Neurology) program. The population for study were divided into four groups: those from North and West Vancouver who used Lions Gate Hospital, patients from the rest of the Greater Vancouver Regional District (G.V.R.D.) who used other G.V.R.D. hospitals, arid to allow for 'spill-out' cases, those from North and West Vancouver who used other hospitals in the province and those from the rest of the G.V.R.D. who used Lions Gate Hospital. The methodology involved the use of a multiple time series design which would allow some comparison before and after the introduction of the CO.L.D. program, as well as comparison between the North Shore and the rest of the G.V.R.D. A regression analysis, using a dummy variable for the CO.L.D. program, on average length, of stay, cases and patient days showed no statistically significant results. The data collection period, 1970 to 1979/80, does not provide conclusive answers for Diabetic Day Care, introduced at Lions Gate Hospital in 1966 and in some of the hospitals of the rest of the G.V.R.D. in 1972, or for the Neuro program, introduced at Lions Gate Hospital in 1979. However, population and age adjusted cases and patient days for all three programs are consistently higher in the rest of the G.V.R.D. when compared with North and West Vancouver and deserve further investigation. The implications from this study, that there is no impact from medical day care, programs on rates of inpatient use, is consistent with similar studies on Diabetic Day Care and Day Care Surgery. The health care system does not seem to be able to respond to innovations of this type and they are additions to existing services.

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