Did Duty Hour Reform Lead to Better Outcomes Among the Highest Risk Patients?
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Earlier work demonstrated that ACGME duty hour reform did not adversely affect mortality, with slight improvement noted among specific subgroups.
To determine whether resident duty hour reform differentially affected the mortality risk of high severity patients or patients who experienced post-operative complications (failure-to-rescue).
Observational study using interrupted time series analysis with data from July 1, 2000 - June 30, 2005. Fixed effects logistic regression was used to examine the change in the odds of mortality or failure-to-rescue (FTR) in more versus less teaching-intensive hospitals before and after duty hour reform.
All unique Medicare patients (n = 8,529,595) admitted to short-term acute care non-federal hospitals and all unique VA patients (n = 318,636 patients) with principal diagnoses of acute myocardial infarction, congestive heart failure, gastrointestinal bleeding, stroke or a DRG classification of general, orthopedic or vascular surgery.
Measurements and Main Results
We measured mortality within 30 days of hospital admission and FTR, measured by death among patients who experienced a surgical complication. The odds of mortality and FTR generally changed at similar rates for higher and lower risk patients in more vs. less teaching intensive hospitals. For example, comparing the mortality risk for the 10% of Medicare patients with highest risk to the other 90% of patients in post-reform year 1 for combined medical an OR of 1.01 [95% CI 0.90, 1.13], for combined surgical an OR of 0.91 [95% CI 0.80, 1.04], and for FTR an OR of 0.94 [95% CI 0.80, 1.09]. Findings were similar in year 2 for both Medicare and VA. The two exceptions were a relative increase in mortality for the highest risk medical (OR 1.63 [95% CI 1.08, 2.46]) and a relative decrease in the high risk surgical patients within VA in post-reform year 1 (OR 0.52 [95% CI 0.29, 0.96]).
ACGME duty hour reform was not associated with any consistent improvements or worsening in mortality or failure-to-rescue rates for high risk medical or surgical patients.
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- Did Duty Hour Reform Lead to Better Outcomes Among the Highest Risk Patients?
Journal of General Internal Medicine
Volume 24, Issue 10 , pp 1149-1155
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- medical errors internship and residency
- education, medical, graduate
- personnel staffing and scheduling
- continuity of patient care
- Industry Sectors
- Kevin G. Volpp MD, PhD (1) (2) (3) (4)
- Amy K. Rosen PhD (5) (6)
- Paul R. Rosenbaum PhD (7)
- Patrick S. Romano MD, MPH (8)
- Kamal M.F. Itani MD (9)
- Lisa Bellini MD (2)
- Orit Even-Shoshan MS (10) (13)
- Liyi Cen MS (2)
- Yanli Wang MS (10)
- Michael J. Halenar BA (1) (2)
- Jeffrey H. Silber MD, PhD (10) (11) (12) (13) (3)
- Author Affiliations
- 1. Center for Health Equity Research and Promotion, Veteran’s Administration Hospital, 1232 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104–6021, USA
- 2. Department of Medicine, The University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- 3. Department of Health Care Management, The Wharton School, The University of Pennsylvania, Philadelphia, PA, USA
- 4. Center for Health Incentives, The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA, USA
- 5. Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
- 6. Center for Health Quality, Outcomes and Economic Research, Veteran’s Administration Hospital, Bedford, MA, USA
- 7. Department of Statistics, The Wharton School, The University of Pennsylvania, Philadelphia, PA, USA
- 8. Division of General Medicine and Center for Healthcare Policy and Research, University of California Davis School of Medicine, Davis, CA, USA
- 9. Department of Surgery, VA Boston Health Care System and Boston University, Boston, MA, USA
- 10. Center for Outcomes Research, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- 13. The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA, USA
- 11. The Department of Pediatrics, The University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- 12. The Department Anesthesiology and Critical Care, The University of Pennsylvania School of Medicine, Philadelphia, PA, USA