Teaching Hospital Five-Year Mortality Trends in the Wake of Duty Hour Reforms
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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.
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.
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.
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.
All-location mortality within 30 days of hospital admission.
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]).
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.
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- Teaching Hospital Five-Year Mortality Trends in the Wake of Duty Hour Reforms
Journal of General Internal Medicine
Volume 28, Issue 8 , pp 1048-1055
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- patient outcomes
- duty hour reform
- administrative data
- Industry Sectors
- Kevin G. Volpp MD, PhD (1) (2) (3) (4)
- Dylan S. Small PhD (5)
- Patrick S. Romano MD, MPH (6)
- Kamal M. F. Itani MD (7)
- Amy K. Rosen PhD (8) (9)
- Orit Even-Shoshan MS (10) (12)
- Yanli Wang MS (10)
- Lisa Bellini MD (2)
- Michael J. Halenar BA (1) (2)
- Sophia Korovaichuk BA (10)
- Jingsan Zhu MBA (2) (4)
- Jeffrey H. Silber MD, PhD (10) (11) (12) (3)
- Author Affiliations
- 1. Center for Health Equity Research and Promotion, Veteran’s Administration Hospital, 1120 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA
- 2. Department of Medicine, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
- 3. Department of Health Care Management, The Wharton School, The University of Pennsylvania, Philadelphia, PA, USA
- 4. The Leonard Davis Institute, Center for Health Incentives and Behavioral Economics, The University of Pennsylvania, Philadelphia, PA, USA
- 5. Department of Statistics, The Wharton School, The University of Pennsylvania, Philadelphia, PA, USA
- 6. Division of General Medicine and Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, CA, USA
- 7. Department of Surgery, VA Boston Healthcare System and Boston University, Boston, MA, USA
- 8. Center for Organization, Leadership and Management Research, VA Boston Healthcare System, Boston, MA, USA
- 9. Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
- 10. Center for Outcomes Research, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- 12. Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
- 11. The Departments of Pediatrics and Anesthesiology and Critical Care, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA