The Impact of Resident Duty Hour Reform on Hospital Readmission Rates Among Medicare Beneficiaries
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A key goal of resident duty hour reform by the Accreditation Council for Graduate Medical Education (ACGME) in 2003 was to improve patient outcomes.
To assess whether the reform led to a change in readmission rates.
Observational study using multiple time series analysis with hospital discharge data from July 1, 2000 to June 30, 2005. Fixed effects logistic regression was used to examine the change in the odds of readmission in more versus less teaching-intensive hospitals before and after duty hour reform.
All unique Medicare patients (n = 8,282,802) admitted to acute-care nonfederal hospitals with principal diagnoses of acute myocardial infarction, congestive heart failure, gastrointestinal bleeding, or stroke (combined medical group), or a DRG classification of general, orthopedic, or vascular surgery (combined surgical group).
Primary outcome was 30-day all-cause readmission. Secondary outcomes were (1) readmission or death within 30 days of discharge, and (2) readmission, death during the index admission, or death within 30 days of discharge.
For the combined medical group, there was no evidence of a change in readmission rates in more versus less teaching-intensive hospitals [OR = 0.99 (95% CI 0.94, 1.03) in post-reform year 1 and OR = 0.99 (95% CI 0.95, 1.04) in post-reform year 2]. There was also no evidence of relative changes in readmission rates for the combined surgical group: OR = 1.03 (95% CI 0.98, 1.08) for post-reform year 1 and OR = 1.02 (95% CI 0.98, 1.07) for post-reform year 2. Findings for the secondary outcomes combining readmission and death were similar.
Among Medicare beneficiaries, there were no changes in hospital readmission rates associated with resident duty hour reform.
- Statement of Justification/Impact for the Final Approval of Common Standards Related to Resident Duty Hours. [accessed 2010 October 4]; available from: http://www.acgme.org/acWebsite/dutyHours/dh_impactStatement.pdf.
- Drazen, JM (2004) Awake and informed. N Engl J Med 351: pp. 1884 CrossRef
- Mukherjee, S (2004) A precarious exchange. N Engl J Med 351: pp. 1822-4 CrossRef
- Ofri, D (2004) Residency regulations–resisting our reflexes. N Engl J Med 351: pp. 1824-6 CrossRef
- Volpp, KG (2007) Mortality among hospitalized Medicare beneficiaries in the first 2 years following ACGME resident duty hour reform. JAMA 298: pp. 975-83 CrossRef
- Volpp, KG (2007) Mortality among patients in VA hospitals in the first 2 years following ACGME resident duty hour reform. JAMA 298: pp. 984-92 CrossRef
- Shetty, KD, Bhattacharya, J (2007) Changes in hospital mortality associated with residency work-hour regulations. Ann Intern Med 147: pp. 73-80
- Rosen, AK (2009) Effects of resident duty hour reform on surgical and procedural patient safety indicators among hospitalized veterans health administration and medicare patients. Med Care 47: pp. 723-31 CrossRef
- Silber, JH (2009) Prolonged hospital stay and the resident duty hour rules of 2003. Med Care 47: pp. 1191-200 CrossRef
- Volpp, KG (2009) Did duty hour reform lead to better outcomes among the highest risk patients?. J Gen Intern Med 24: pp. 1149-55 CrossRef
- Jencks, SF, Williams, MV, Coleman, EA (2009) Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 360: pp. 1418-28 CrossRef
- Ashton, CM (1997) The association between the quality of inpatient care and early readmission: a meta-analysis of the evidence. Med Care 35: pp. 1044-59 CrossRef
- Walraven, C (2010) Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community. CMAJ 182: pp. 551-7
- Smith, DM (2000) Predicting non-elective hospital readmissions: a multi-site study. J Clin Epidemiol 53: pp. 1113-1118 CrossRef
- Desai, MM (2009) Statistical models and patient predictors of readmission for acute myocardial infarction: a systematic review. Circ Cardiovasc Qual Outcomes 2: pp. 500-7 CrossRef
- Ross, JS (2008) Statistical models and patient predictors of readmission for heart failure: a systematic review. Arch Intern Med 168: pp. 1371-86 CrossRef
- Billings, J (2006) Case finding for patients at risk of readmission to hospital: development of algorithm to identify high risk patients. BMJ 333: pp. 327 CrossRef
- Kripalani, S (2007) Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA 297: pp. 831-41 CrossRef
- Shepperd S, et al. Discharge planning from hospital to home. Cochrane Database Syst Rev, (1): p. CD000313
- Kaanan, S (2009) Homeward bound: nine patient-centered programs cut readmissions. California Health Care Foundation, Oakland
- Keeler, EB (1992) Hospital characteristics and quality of care. JAMA 268: pp. 1709-14 CrossRef
- Allison, JJ (2000) Relationship of hospital teaching status with quality of care and mortality for medicare patients with acute MI. JAMA 284: pp. 1256-62 CrossRef
- Taylor, DH, Whellan, DJ, Sloan, FA (1999) Effects of admission to a teaching hospital on the cost and quality of care for medicare beneficiaries. N Engl J Med 340: pp. 293-299 CrossRef
- Cox, DR (1957) Note on grouping. J Am Stat Assoc 52: pp. 543-547 CrossRef
- Cochran, WG (1968) The effectiveness of adjustment by subclassification in removing bias in observational studies. Biometrics 24: pp. 295-313 CrossRef
- Elixhauser, A (1998) Comorbidity measures for use with administrative data. Med Care 36: pp. 8-27 CrossRef
- Healthcare Cost and Utilization Project Comorbidity Software, Version 3.0. [accessed 2010 October 4]; Available from: http://www.hcup-us.ahrq.gov/toolssoftware/comorbidity/comorbidity.jsp.
- Glance, LG (2006) Does date stamping ICD-9-CM codes increase the value of clinical information in administrative data?. Health Serv Res 41: pp. 231-51 CrossRef
- Quan, H (2005) Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43: pp. 1130-9 CrossRef
- Southern, DA, Quan, H, Ghali, WA (2004) Comparison of the elixhauser and charlson/deyo methods of comorbidity measurement in administrative data. Med Care 42: pp. 355-60 CrossRef
- Stukenborg, GJ, Wagner, DP, Connors, AF (2001) Comparison of the performance of two comorbidity measures, with and without information from prior hospitalizations. Med Care 39: pp. 727-39 CrossRef
- Deyo, RA, Cherkin, DC, Ciol, MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45: pp. 613-9 CrossRef
- Campbell, D, Stanley, J (1963) Experimental and quasi-experimental designs for research. Houghton Mifflin Company, Dallas
- Shadish, W, Cook, T, Campbell, D (2002) Experimental and quasi-experimental designs for generalized causal inference. Houghton-Mifflin, Boston
- Rosenbaum, P (2001) Stability in the absence of treatment. J Am Stat Assoc 96: pp. 210-219 CrossRef
- Thomas, JW (1996) Does risk-adjusted readmission rate provide valid information on hospital quality?. Inquiry 33: pp. 258-70
- Jack, BW (2009) A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med 150: pp. 178-87
- Coleman, EA (2006) The care transitions intervention: results of a randomized controlled trial. Arch Intern Med 166: pp. 1822-8 CrossRef
- Al-Rashed, SA (2002) The value of inpatient pharmaceutical counselling to elderly patients prior to discharge. Br J Clin Pharmacol 54: pp. 657-64 CrossRef
- Misky GJ, Wald HL, Coleman EA. Post-hospitalization transitions: Examining the effects of timing of primary care provider follow-up. J Hosp Med. 2010;5(7):392–7.
- Kripalani, S (2007) Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists. J Hosp Med 2: pp. 314-23 CrossRef
- Landrigan, CP (2006) Interns' compliance with accreditation council for graduate medical education work-hour limits. JAMA 296: pp. 1063-70 CrossRef
- Shonka, DC (2009) Four years of accreditation council of graduate medical education duty hour regulations: have they made a difference?. Laryngoscope 119: pp. 635-9 CrossRef
- Horwitz, LI (2007) Changes in outcomes for internal medicine inpatients after work-hour regulations. Ann Intern Med 147: pp. 97-103
- Optimizing graduate medical trainee (resident) hours and work schedules to improve patient safety. 2008, Institute of Medicine.
- Wayne, DB, Arora, VM (2009) Duty hour reform and internal medicine residency training: no time to lose. J Gen Intern Med 24: pp. 1169-70 CrossRef
- Acute myocardial infarction (AMI): thirty-day all-cause risk standardized readmission rate following AMI hospitalization. National Quality Measures Clearinghouse 2009 [accessed 2010 October 4]; Available from: http://www.qualitymeasures.ahrq.gov/content.aspx?id=14749&search=readmission.
- The Impact of Resident Duty Hour Reform on Hospital Readmission Rates Among Medicare Beneficiaries
Journal of General Internal Medicine
Volume 26, Issue 4 , pp 405-411
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- education, medical, graduate
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- Author Affiliations
- 2. Department of Public Health and Department of Medicine, Weill Cornell Medical College, 402 E. 67th St., New York, NY, 10065, USA
- 3. University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- 4. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- 5. The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
- 6. Center for Outcomes Research, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- 11. Department of Health Policy and Research, Boston University School of Public Health, Boston, MA, USA
- 7. VA Boston Health Care System, Boston, MA, USA
- 9. Division of General Medicine and Center for Healthcare Policy and Research, UC Davis School of Medicine, Sacramento, CA, USA
- 10. Harvard Medical School, Boston, MA, USA
- 8. Boston University, Boston, MA, USA
- 1. Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA, USA