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.
- 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