Journal of General Internal Medicine

, Volume 28, Issue 8, pp 1048–1055

Teaching Hospital Five-Year Mortality Trends in the Wake of Duty Hour Reforms

Authors

    • Center for Health Equity Research and PromotionVeteran’s Administration Hospital
    • Department of Medicine, Perelman School of MedicineThe University of Pennsylvania
    • Department of Health Care Management, The Wharton SchoolThe University of Pennsylvania
    • The Leonard Davis Institute, Center for Health Incentives and Behavioral EconomicsThe University of Pennsylvania
  • Dylan S. Small
    • Department of Statistics, The Wharton SchoolThe University of Pennsylvania
  • Patrick S. Romano
    • Division of General Medicine and Center for Healthcare Policy and ResearchUniversity of California Davis School of Medicine
  • Kamal M. F. Itani
    • Department of SurgeryVA Boston Healthcare System and Boston University
  • Amy K. Rosen
    • Center for Organization, Leadership and Management ResearchVA Boston Healthcare System
    • Department of Health Policy and ManagementBoston University School of Public Health
  • Orit Even-Shoshan
    • Center for Outcomes ResearchThe Children’s Hospital of Philadelphia
    • Leonard Davis Institute of Health Economics
  • Yanli Wang
    • Center for Outcomes ResearchThe Children’s Hospital of Philadelphia
  • Lisa Bellini
    • Department of Medicine, Perelman School of MedicineThe University of Pennsylvania
  • Michael J. Halenar
    • Center for Health Equity Research and PromotionVeteran’s Administration Hospital
    • Department of Medicine, Perelman School of MedicineThe University of Pennsylvania
  • Sophia Korovaichuk
    • Center for Outcomes ResearchThe Children’s Hospital of Philadelphia
  • Jingsan Zhu
    • Department of Medicine, Perelman School of MedicineThe University of Pennsylvania
    • The Leonard Davis Institute, Center for Health Incentives and Behavioral EconomicsThe University of Pennsylvania
  • Jeffrey H. Silber
    • Department of Health Care Management, The Wharton SchoolThe University of Pennsylvania
    • Center for Outcomes ResearchThe Children’s Hospital of Philadelphia
    • The Departments of Pediatrics and Anesthesiology and Critical Care, Perelman School of MedicineThe University of Pennsylvania
    • Leonard Davis Institute of Health Economics
Original Research

DOI: 10.1007/s11606-013-2401-9

Cite this article as:
Volpp, K.G., Small, D.S., Romano, P.S. et al. J GEN INTERN MED (2013) 28: 1048. doi:10.1007/s11606-013-2401-9

ABSTRACT

BACKGROUND

The Accreditation Council for Graduate Medical Education (ACGME) implemented duty hour regulations for residents in 2003 and again in 2011. While previous studies showed no systematic impacts in the first 2 years post-reform, the impact on mortality in subsequent years has not been examined.

OBJECTIVE

To determine whether duty hour regulations were associated with changes in mortality among Medicare patients in hospitals of different teaching intensity after the first 2 years post-reform.

DESIGN

Observational study using interrupted time series analysis with data from July 1, 2000 to June 30, 2008. Logistic regression was used to examine the change in mortality for patients in more versus less teaching-intensive hospitals before (2000–2003) and after (2003–2008) duty hour reform, adjusting for patient comorbidities, time trends, and hospital site.

PATIENTS

Medicare patients (n = 13,678,956) admitted to short-term acute care non-federal hospitals with principal diagnoses of acute myocardial infarction (AMI), gastrointestinal bleeding, or congestive heart failure (CHF); or a diagnosis-related group (DRG) classification of general, orthopedic, or vascular surgery.

MAIN MEASURE

All-location mortality within 30 days of hospital admission.

KEY RESULTS

In medical and surgical patients, there were no consistent changes in the odds of mortality at more vs. less teaching intensive hospitals in post-reform years 1–3. However, there were significant relative improvements in mortality for medical patients in the fourth and fifth years post-reform: Post4 (OR 0.88, 95 % CI [0.93–0.94]); Post5 (OR 0.87, [0.82–0.92]) and for surgical patients in the fifth year post-reform: Post5 (OR 0.91, [0.85–0.96]).

CONCLUSIONS

Duty hour reform was associated with no significant change in mortality in the early years after implementation, and with a trend toward improved mortality among medical patients in the fourth and fifth years. It is unclear whether improvements in outcomes long after implementation can be attributed to the reform, but concerns about worsening outcomes seem unfounded.

KEY WORDS

patient outcomes mortality duty hour reform ACGME administrative data

Copyright information

© Society of General Internal Medicine 2013