Community hospitals and district general hospital medical bed use by elderly people: a study of 342 general practitioner beds in Oxfordshire

Background: rural community hospitals (CHs) may reduce the use of district general hospital (DGH) medical beds by elderly people, However, DGH medical bed usage may be influenced more by distance from a DGH than by the existence of CH beds, Objectives: to examine the effect of CHs and distance from general practitioner practice on medical bed use by elderly people. Subjects: all residents aged 65 and over admitted to a DGH or CH, Design: multiple regression analyses of bed days occupied/year/1000 elderly people registered with practices with (n = 41) and without (n = 33) access to a CH. Main outcome measures: the relation between DGH and CH bed use, practice distance from a DGH or CH and the number of CH beds. Results: both DGH and CH bed use were strongly inversely correlated with the distance between practice surgery and hospital. Practices with access to CHs were further away from the DGHs and used 50% fewer DGH beds but 40% more CH and DGH medical beds combined than those without CH access. There was a weak inverse correlation between DGH and CH bed use: on average, access to each CH bed was associated with the use of 0.16 fewer DGH beds. Conclusions: CHs had only a small effect on the use of DGH medical beds. Distance from a hospital and the level of CH bed provision were the principal determinants in the variation in bed use.