Journal of General Internal Medicine

, Volume 26, Issue 4, pp 405–411 | Cite as

The Impact of Resident Duty Hour Reform on Hospital Readmission Rates Among Medicare Beneficiaries

  • Matthew J. Press
  • Jeffrey H. Silber
  • Amy K. Rosen
  • Patrick S. Romano
  • Kamal M. F. Itani
  • Jingsan Zhu
  • Yanli Wang
  • Orit Even-Shoshan
  • Michael J. Halenar
  • Kevin G. Volpp
Original Research

ABSTRACT

Background

A key goal of resident duty hour reform by the Accreditation Council for Graduate Medical Education (ACGME) in 2003 was to improve patient outcomes.

Objective

To assess whether the reform led to a change in readmission rates.

Design

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.

Participants

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).

Main measures

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.

Key Results

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.

Conclusions

Among Medicare beneficiaries, there were no changes in hospital readmission rates associated with resident duty hour reform.

KEY WORDS

education, medical, graduate hospital readmission 

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Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Matthew J. Press
    • 2
  • Jeffrey H. Silber
    • 3
    • 4
    • 5
    • 6
  • Amy K. Rosen
    • 7
    • 11
  • Patrick S. Romano
    • 9
  • Kamal M. F. Itani
    • 7
    • 8
    • 10
  • Jingsan Zhu
    • 3
  • Yanli Wang
    • 6
  • Orit Even-Shoshan
    • 4
    • 6
  • Michael J. Halenar
    • 1
    • 3
  • Kevin G. Volpp
    • 1
    • 3
    • 4
    • 5
  1. 1.Center for Health Equity Research and PromotionPhiladelphia VA Medical CenterPhiladelphiaUSA
  2. 2.Department of Public Health and Department of MedicineWeill Cornell Medical CollegeNew YorkUSA
  3. 3.University of Pennsylvania School of MedicinePhiladelphiaUSA
  4. 4.Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaUSA
  5. 5.The Wharton SchoolUniversity of PennsylvaniaPhiladelphiaUSA
  6. 6.Center for Outcomes ResearchThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  7. 7.VA Boston Health Care SystemBostonUSA
  8. 8.Boston UniversityBostonUSA
  9. 9.Division of General Medicine and Center for Healthcare Policy and ResearchUC Davis School of MedicineSacramentoUSA
  10. 10.Harvard Medical SchoolBostonUSA
  11. 11.Department of Health Policy and ResearchBoston University School of Public HealthBostonUSA

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