BACKGROUND: 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. OBJECTIVE: 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. DESIGN: 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. PATIENTS: 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. MAIN MEASURE: All-location mortality within 30 days of hospital admission. KEY RESULTS: 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]). CONCLUSIONS: 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.
BACKGROUND: 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. OBJECTIVE: 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. DESIGN: 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. PATIENTS: 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. MAIN MEASURE: All-location mortality within 30 days of hospital admission. KEY RESULTS: 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]). CONCLUSIONS: 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.
Authors: 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 Journal: J Gen Intern Med Date: 2010-11-06 Impact factor: 5.128
Authors: J J Allison; C I Kiefe; N W Weissman; S D Person; M Rousculp; J G Canto; S Bae; O D Williams; R Farmer; R M Centor Journal: JAMA Date: 2000-09-13 Impact factor: 56.272
Authors: Jeffrey H Silber; Paul R Rosenbaum; Amy K Rosen; Patrick S Romano; Kamal M F Itani; Liyi Cen; Lanyu Mi; Michael J Halenar; Orit Even-Shoshan; Kevin G Volpp Journal: Med Care Date: 2009-12 Impact factor: 2.983
Authors: Amy K Rosen; Susan A Loveland; Patrick S Romano; Kamal M F Itani; Jeffrey H Silber; Orit O Even-Shoshan; Michael J Halenar; Yun Teng; Jingsan Zhu; Kevin G Volpp Journal: Med Care Date: 2009-07 Impact factor: 2.983
Authors: Kevin G Volpp; Amy K Rosen; Paul R Rosenbaum; Patrick S Romano; Orit Even-Shoshan; Anne Canamucio; Lisa Bellini; Tiffany Behringer; Jeffrey H Silber Journal: JAMA Date: 2007-09-05 Impact factor: 56.272
Authors: Yuka Kiyota; Sebastian Schneeweiss; Robert J Glynn; Carolyn C Cannuscio; Jerry Avorn; Daniel H Solomon Journal: Am Heart J Date: 2004-07 Impact factor: 4.749
Authors: Jeffrey H Silber; Lisa M Bellini; Judy A Shea; Sanjay V Desai; David F Dinges; Mathias Basner; Orit Even-Shoshan; Alexander S Hill; Lauren L Hochman; Joel T Katz; Richard N Ross; David M Shade; Dylan S Small; Alice L Sternberg; James Tonascia; Kevin G Volpp; David A Asch Journal: N Engl J Med Date: 2019-03-07 Impact factor: 91.245
Authors: Mitesh S Patel; Kevin G Volpp; Dylan S Small; Alexander S Hill; Orit Even-Shoshan; Lisa Rosenbaum; Richard N Ross; Lisa Bellini; Jingsan Zhu; Jeffrey H Silber Journal: JAMA Date: 2014-12-10 Impact factor: 56.272
Authors: Judy A Shea; Jeffrey H Silber; Sanjay V Desai; David F Dinges; Lisa M Bellini; James Tonascia; Alice L Sternberg; Dylan S Small; David M Shade; Joel Thorp Katz; Mathias Basner; Krisda H Chaiyachati; Orit Even-Shoshan; David Westfall Bates; Kevin G Volpp; David A Asch Journal: BMJ Open Date: 2018-09-21 Impact factor: 2.692