Re "A Critique of an Evaluation of the Impact of Hospital Bed Closures on Winnipeg, Canada: Lessons to be Learned from Evaluation Research Methods," by Evelyn Vingilis and Jacquelyn Burkell (author reply follows).

This article discusses the criticisms leveled by Evelyn Vingilis and Jacquelyn Burkell in "A Critique of an Evaluation of the Impact of Hospital Bed Closures on Winnipeg, Canada: Lessons to be Learned from Evaluation Research Methods." Vingilis and Burkell repeatedly mention the inadequacy of using only one year of "follow-up" in determining the impact of bed closures in Winnipeg. We couldn't agree more. It was never our intention to have the "First Report," as the name implies, to be the last word on hospital downsizing in Winnipeg. They wrongly suggest that this design is vulnerable to most of the threats to internal and external validity. They are, in fact, correct that the design is vulnerable to the threat of maturation, but interestingly, one of their suggestions for overcoming this threat would only introduce additional threats to internal validity. In a perfect world, health care researchers could monitor a system for years before reporting on the impact of change. In this less than perfect world, however, policy is made and beds are closed.