Did duty hour reform lead to better outcomes among the highest risk patients?

Kevin G. Volpp, Amy K. Rosen, Paul R. Rosenbaum, Patrick S Romano, Kamal M F Itani, Lisa Bellini, Orit Even-Shoshan, Liyi Cen, Yanli Wang, Michael J. Halenar, Jeffrey H. Silber

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

BACKGROUND: Earlier work demonstrated that ACGME duty hour reform did not adversely affect mortality, with slight improvement noted among specific subgroups. OBJECTIVE: To determine whether resident duty hour reform differentially affected the mortality risk of high severity patients or patients who experienced postoperative complications (failure-to-rescue). DESIGN: Observational study using interrupted time series analysis with data from July 1, 2000 - June 30, 2005. Fixed effects logistic regression was used to examine the change in the odds of mortality or failureto- rescue (FTR) in more versus less teaching-intensive hospitals before and after duty hour reform. PARTICIPANTS: All unique Medicare patients (n= 8,529,595) admitted to short-term acute care nonfederal hospitals and all unique VA patients (n= 318,636 patients) with principal diagnoses of acute myocardial infarction, congestive heart failure, gastrointestinal bleeding, stroke or a DRG classification of general, orthopedic or vascular surgery. MEASUREMENTS AND MAIN RESULTS: We measured mortality within 30 days of hospital admission and FTR, measured by death among patients who experienced a surgical complication. The odds of mortality and FTR generally changed at similar rates for higher and lower risk patients in more vs. less teaching intensive hospitals. For example, comparing the mortality risk for the 10% of Medicare patients with highest risk to the other 90% of patients in post-reform year 1 for combined medical an OR of 1.01 [95% CI 0.90, 1.13], for combined surgical an OR of 0.91 [95% CI 0.80, 1.04], and for FTR an OR of 0.94 [95% CI 0.80, 1.09]. Findings were similar in year 2 for both Medicare and VA. The two exceptions were a relative increase in mortality for the highest risk medical (OR 1.63 [95% CI 1.08, 2.46]) and a relative decrease in the high risk surgical patients within VA in post-reform year 1 (OR 0.52 [95% CI 0.29, 0.96]). CONCLUSIONS: ACGME duty hour reform was not associated with any consistent improvements or worsening in mortality or failure-to-rescue rates for high risk medical or surgical patients.

Original languageEnglish (US)
Pages (from-to)1149-1155
Number of pages7
JournalJournal of General Internal Medicine
Volume24
Issue number10
DOIs
StatePublished - 2009

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Mortality
Medicare
Teaching Hospitals
Diagnosis-Related Groups
Observational Studies
Orthopedics
Blood Vessels
Heart Failure
Logistic Models
Stroke
Myocardial Infarction
Hemorrhage

Keywords

  • Continuity of patient care
  • Education, medical, Graduate
  • Medical errors internship and residency
  • Personnel staffing and scheduling

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Volpp, K. G., Rosen, A. K., Rosenbaum, P. R., Romano, P. S., Itani, K. M. F., Bellini, L., ... Silber, J. H. (2009). Did duty hour reform lead to better outcomes among the highest risk patients? Journal of General Internal Medicine, 24(10), 1149-1155. https://doi.org/10.1007/s11606-009-1011-z

Did duty hour reform lead to better outcomes among the highest risk patients? / Volpp, Kevin G.; Rosen, Amy K.; Rosenbaum, Paul R.; Romano, Patrick S; Itani, Kamal M F; Bellini, Lisa; Even-Shoshan, Orit; Cen, Liyi; Wang, Yanli; Halenar, Michael J.; Silber, Jeffrey H.

In: Journal of General Internal Medicine, Vol. 24, No. 10, 2009, p. 1149-1155.

Research output: Contribution to journalArticle

Volpp, KG, Rosen, AK, Rosenbaum, PR, Romano, PS, Itani, KMF, Bellini, L, Even-Shoshan, O, Cen, L, Wang, Y, Halenar, MJ & Silber, JH 2009, 'Did duty hour reform lead to better outcomes among the highest risk patients?', Journal of General Internal Medicine, vol. 24, no. 10, pp. 1149-1155. https://doi.org/10.1007/s11606-009-1011-z
Volpp, Kevin G. ; Rosen, Amy K. ; Rosenbaum, Paul R. ; Romano, Patrick S ; Itani, Kamal M F ; Bellini, Lisa ; Even-Shoshan, Orit ; Cen, Liyi ; Wang, Yanli ; Halenar, Michael J. ; Silber, Jeffrey H. / Did duty hour reform lead to better outcomes among the highest risk patients?. In: Journal of General Internal Medicine. 2009 ; Vol. 24, No. 10. pp. 1149-1155.
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AU - Itani, Kamal M F

AU - Bellini, Lisa

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AU - Silber, Jeffrey H.

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N2 - BACKGROUND: Earlier work demonstrated that ACGME duty hour reform did not adversely affect mortality, with slight improvement noted among specific subgroups. OBJECTIVE: To determine whether resident duty hour reform differentially affected the mortality risk of high severity patients or patients who experienced postoperative complications (failure-to-rescue). DESIGN: Observational study using interrupted time series analysis with data from July 1, 2000 - June 30, 2005. Fixed effects logistic regression was used to examine the change in the odds of mortality or failureto- rescue (FTR) in more versus less teaching-intensive hospitals before and after duty hour reform. PARTICIPANTS: All unique Medicare patients (n= 8,529,595) admitted to short-term acute care nonfederal hospitals and all unique VA patients (n= 318,636 patients) with principal diagnoses of acute myocardial infarction, congestive heart failure, gastrointestinal bleeding, stroke or a DRG classification of general, orthopedic or vascular surgery. MEASUREMENTS AND MAIN RESULTS: We measured mortality within 30 days of hospital admission and FTR, measured by death among patients who experienced a surgical complication. The odds of mortality and FTR generally changed at similar rates for higher and lower risk patients in more vs. less teaching intensive hospitals. For example, comparing the mortality risk for the 10% of Medicare patients with highest risk to the other 90% of patients in post-reform year 1 for combined medical an OR of 1.01 [95% CI 0.90, 1.13], for combined surgical an OR of 0.91 [95% CI 0.80, 1.04], and for FTR an OR of 0.94 [95% CI 0.80, 1.09]. Findings were similar in year 2 for both Medicare and VA. The two exceptions were a relative increase in mortality for the highest risk medical (OR 1.63 [95% CI 1.08, 2.46]) and a relative decrease in the high risk surgical patients within VA in post-reform year 1 (OR 0.52 [95% CI 0.29, 0.96]). CONCLUSIONS: ACGME duty hour reform was not associated with any consistent improvements or worsening in mortality or failure-to-rescue rates for high risk medical or surgical patients.

AB - BACKGROUND: Earlier work demonstrated that ACGME duty hour reform did not adversely affect mortality, with slight improvement noted among specific subgroups. OBJECTIVE: To determine whether resident duty hour reform differentially affected the mortality risk of high severity patients or patients who experienced postoperative complications (failure-to-rescue). DESIGN: Observational study using interrupted time series analysis with data from July 1, 2000 - June 30, 2005. Fixed effects logistic regression was used to examine the change in the odds of mortality or failureto- rescue (FTR) in more versus less teaching-intensive hospitals before and after duty hour reform. PARTICIPANTS: All unique Medicare patients (n= 8,529,595) admitted to short-term acute care nonfederal hospitals and all unique VA patients (n= 318,636 patients) with principal diagnoses of acute myocardial infarction, congestive heart failure, gastrointestinal bleeding, stroke or a DRG classification of general, orthopedic or vascular surgery. MEASUREMENTS AND MAIN RESULTS: We measured mortality within 30 days of hospital admission and FTR, measured by death among patients who experienced a surgical complication. The odds of mortality and FTR generally changed at similar rates for higher and lower risk patients in more vs. less teaching intensive hospitals. For example, comparing the mortality risk for the 10% of Medicare patients with highest risk to the other 90% of patients in post-reform year 1 for combined medical an OR of 1.01 [95% CI 0.90, 1.13], for combined surgical an OR of 0.91 [95% CI 0.80, 1.04], and for FTR an OR of 0.94 [95% CI 0.80, 1.09]. Findings were similar in year 2 for both Medicare and VA. The two exceptions were a relative increase in mortality for the highest risk medical (OR 1.63 [95% CI 1.08, 2.46]) and a relative decrease in the high risk surgical patients within VA in post-reform year 1 (OR 0.52 [95% CI 0.29, 0.96]). CONCLUSIONS: ACGME duty hour reform was not associated with any consistent improvements or worsening in mortality or failure-to-rescue rates for high risk medical or surgical patients.

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