Original Research

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

  • Kevin G. VolppAffiliated withCenter for Health Equity Research and Promotion, Veteran’s Administration HospitalDepartment of Medicine, Perelman School of Medicine, The University of PennsylvaniaDepartment of Health Care Management, The Wharton School, The University of PennsylvaniaThe Leonard Davis Institute, Center for Health Incentives and Behavioral Economics, The University of Pennsylvania Email author 
  • , Dylan S. SmallAffiliated withDepartment of Statistics, The Wharton School, The University of Pennsylvania
  • , Patrick S. RomanoAffiliated withDivision of General Medicine and Center for Healthcare Policy and Research, University of California Davis School of Medicine
  • , Kamal M. F. ItaniAffiliated withDepartment of Surgery, VA Boston Healthcare System and Boston University
  • , Amy K. RosenAffiliated withCenter for Organization, Leadership and Management Research, VA Boston Healthcare SystemDepartment of Health Policy and Management, Boston University School of Public Health
  • , Orit Even-ShoshanAffiliated withCenter for Health Equity Research and Promotion, Veteran’s Administration HospitalCenter for Outcomes Research, The Children’s Hospital of PhiladelphiaLeonard Davis Institute of Health Economics
  • , Yanli WangAffiliated withCenter for Health Equity Research and Promotion, Veteran’s Administration HospitalCenter for Outcomes Research, The Children’s Hospital of Philadelphia
  • , Lisa BelliniAffiliated withDepartment of Medicine, Perelman School of Medicine, The University of Pennsylvania
  • , Michael J. HalenarAffiliated withCenter for Health Equity Research and Promotion, Veteran’s Administration HospitalDepartment of Medicine, Perelman School of Medicine, The University of Pennsylvania
    • , Sophia KorovaichukAffiliated withCenter for Health Equity Research and Promotion, Veteran’s Administration HospitalCenter for Outcomes Research, The Children’s Hospital of Philadelphia
    • , Jingsan ZhuAffiliated withDepartment of Medicine, Perelman School of Medicine, The University of PennsylvaniaThe Leonard Davis Institute, Center for Health Incentives and Behavioral Economics, The University of Pennsylvania
    • , Jeffrey H. SilberAffiliated withCenter for Health Equity Research and Promotion, Veteran’s Administration HospitalDepartment of Health Care Management, The Wharton School, The University of PennsylvaniaCenter for Outcomes Research, The Children’s Hospital of PhiladelphiaThe Departments of Pediatrics and Anesthesiology and Critical Care, Perelman School of Medicine, The University of PennsylvaniaLeonard Davis Institute of Health Economics

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

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