Journal of General Internal Medicine

, 24:1149

Did Duty Hour Reform Lead to Better Outcomes Among the Highest Risk Patients?

Authors

    • Center for Health Equity Research and PromotionVeteran’s Administration Hospital
    • Department of MedicineThe University of Pennsylvania School of Medicine
    • Department of Health Care Management, The Wharton SchoolThe University of Pennsylvania
    • Center for Health Incentives, The Leonard Davis Institute of Health EconomicsThe University of Pennsylvania
  • Amy K. Rosen
    • Department of Health Policy and ManagementBoston University School of Public Health
    • Center for Health Quality, Outcomes and Economic ResearchVeteran’s Administration Hospital
  • Paul R. Rosenbaum
    • 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 Health Care System and Boston University
  • Lisa Bellini
    • Department of MedicineThe University of Pennsylvania School of Medicine
  • Orit Even-Shoshan
    • Center for Outcomes ResearchThe Children’s Hospital of Philadelphia
    • The Leonard Davis Institute of Health EconomicsThe University of Pennsylvania
  • Liyi Cen
    • Department of MedicineThe University of Pennsylvania School of Medicine
  • Yanli Wang
    • Center for Outcomes ResearchThe Children’s Hospital of Philadelphia
  • Michael J. Halenar
    • Center for Health Equity Research and PromotionVeteran’s Administration Hospital
    • Department of MedicineThe University of Pennsylvania School of Medicine
  • Jeffrey H. Silber
    • Department of Health Care Management, The Wharton SchoolThe University of Pennsylvania
    • Center for Outcomes ResearchThe Children’s Hospital of Philadelphia
    • The Department of PediatricsThe University of Pennsylvania School of Medicine
    • The Department Anesthesiology and Critical CareThe University of Pennsylvania School of Medicine
    • The Leonard Davis Institute of Health EconomicsThe University of Pennsylvania
Hospital Medicine

DOI: 10.1007/s11606-009-1011-z

Cite this article as:
Volpp, K.G., Rosen, A.K., Rosenbaum, P.R. et al. J GEN INTERN MED (2009) 24: 1149. doi:10.1007/s11606-009-1011-z

Abstract

Background

Earlier work demonstrated that ACGME duty hour reform did not adversely affect mortality, with slight improvement noted among specific subgroups.

Objective

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).

Design

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.

Participants

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]).

Conclusions

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.

KEY WORDS

medical errors internship and residencyeducation, medical, graduatepersonnel staffing and schedulingcontinuity of patient care

Copyright information

© Society of General Internal Medicine 2009