Mortality among hospitalized medicare beneficiaries in the first 2 years following ACGME resident duty hour reform

Kevin G. Volpp, Amy K. Rosen, Paul R. Rosenbaum, Patrick S Romano, Orit Even-Shoshan, Yanli Wang, Lisa Bellini, Tiffany Behringer, Jeffrey H. Silber

Research output: Contribution to journalArticle

250 Citations (Scopus)

Abstract

Context: The Accreditation Council for Graduate Medical Education (ACGME) implemented duty hour regulations for physicians-in-training throughout the United States on July 1, 2003. The association of duty hour reform with mortality among patients in teaching hospitals nationally has not been well established. Objective: To determine whether the change in duty hour regulations was associated with relative changes in mortality among Medicare patients in hospitals of different teaching intensity. Design, Setting, and Patients: An observational study of all unique Medicare patients (N=8 529 595) admitted to short-term, acute-care, general US nonfederal hospitals (N=3321) using interrupted time series analysis with data from July 1, 2000, to June 30, 2005. All Medicare patients had principal diagnoses of acute myocardial infarction, congestive heart failure, gastrointestinal bleeding, or stroke or a diagnosis related group classification of general, orthopedic, or vascular surgery. Logistic regression was used to examine the change in mortality for patients in more vs less teaching-intensive hospitals before (academic years 2000-2003) and after (academic years 2003-2005) duty hour reform, adjusting for patient comorbidities, common time trends, and hospital site. Main Outcome Measure: All-location mortality within 30 days of hospital admission. Results: In medical and surgical patients, no significant relative increases or decreases in the odds of mortality for more vs less teaching-intensive hospitals were observed in either postreform year 1 (combined medical conditions group: odds ratio [OR], 1.03; 95% confidence interval [CI], 0.98-1.07; and combined surgical categories group: OR, 1.05; 95% CI, 0.98-1.12) or postreform year 2 (combined medical conditions group: OR, 1.03; 95% CI, 0.99-1.08; and combined surgical categories group: OR, 1.01; 95% CI, 0.95-1.08) compared with the prereform years. The only condition for which there was a relative increase in mortality in more teaching-intensive hospitals postreform was stroke, but this association preceded the onset of duty hour reform. Compared with nonteaching hospitals, the most teaching-intensive hospitals had an absolute change in mortality from prereform year 1 to postreform year 2 of 0.42 percentage points (4.4% relative increase) for patients in the combined medical conditions group and 0.05 percentage points (2.3% relative increase) for patients in the combined surgical categories group, neither of which were statistically significant. Conclusion: The ACGME duty hour reform was not associated with either significant worsening or improvement in mortality for Medicare patients in the first 2 years after implementation.

Original languageEnglish (US)
Pages (from-to)975-983
Number of pages9
JournalJournal of the American Medical Association
Volume298
Issue number9
DOIs
StatePublished - Sep 5 2007
Externally publishedYes

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Graduate Medical Education
Accreditation
Medicare
Mortality
Teaching Hospitals
Odds Ratio
Confidence Intervals
Stroke
Diagnosis-Related Groups
Observational Studies
Orthopedics
Blood Vessels
Comorbidity
Heart Failure
Logistic Models
Myocardial Infarction
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Mortality among hospitalized medicare beneficiaries in the first 2 years following ACGME resident duty hour reform. / Volpp, Kevin G.; Rosen, Amy K.; Rosenbaum, Paul R.; Romano, Patrick S; Even-Shoshan, Orit; Wang, Yanli; Bellini, Lisa; Behringer, Tiffany; Silber, Jeffrey H.

In: Journal of the American Medical Association, Vol. 298, No. 9, 05.09.2007, p. 975-983.

Research output: Contribution to journalArticle

Volpp, KG, Rosen, AK, Rosenbaum, PR, Romano, PS, Even-Shoshan, O, Wang, Y, Bellini, L, Behringer, T & Silber, JH 2007, 'Mortality among hospitalized medicare beneficiaries in the first 2 years following ACGME resident duty hour reform', Journal of the American Medical Association, vol. 298, no. 9, pp. 975-983. https://doi.org/10.1001/jama.298.9.975
Volpp, Kevin G. ; Rosen, Amy K. ; Rosenbaum, Paul R. ; Romano, Patrick S ; Even-Shoshan, Orit ; Wang, Yanli ; Bellini, Lisa ; Behringer, Tiffany ; Silber, Jeffrey H. / Mortality among hospitalized medicare beneficiaries in the first 2 years following ACGME resident duty hour reform. In: Journal of the American Medical Association. 2007 ; Vol. 298, No. 9. pp. 975-983.
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title = "Mortality among hospitalized medicare beneficiaries in the first 2 years following ACGME resident duty hour reform",
abstract = "Context: The Accreditation Council for Graduate Medical Education (ACGME) implemented duty hour regulations for physicians-in-training throughout the United States on July 1, 2003. The association of duty hour reform with mortality among patients in teaching hospitals nationally has not been well established. Objective: To determine whether the change in duty hour regulations was associated with relative changes in mortality among Medicare patients in hospitals of different teaching intensity. Design, Setting, and Patients: An observational study of all unique Medicare patients (N=8 529 595) admitted to short-term, acute-care, general US nonfederal hospitals (N=3321) using interrupted time series analysis with data from July 1, 2000, to June 30, 2005. All Medicare patients had principal diagnoses of acute myocardial infarction, congestive heart failure, gastrointestinal bleeding, or stroke or a diagnosis related group classification of general, orthopedic, or vascular surgery. Logistic regression was used to examine the change in mortality for patients in more vs less teaching-intensive hospitals before (academic years 2000-2003) and after (academic years 2003-2005) duty hour reform, adjusting for patient comorbidities, common time trends, and hospital site. Main Outcome Measure: All-location mortality within 30 days of hospital admission. Results: In medical and surgical patients, no significant relative increases or decreases in the odds of mortality for more vs less teaching-intensive hospitals were observed in either postreform year 1 (combined medical conditions group: odds ratio [OR], 1.03; 95{\%} confidence interval [CI], 0.98-1.07; and combined surgical categories group: OR, 1.05; 95{\%} CI, 0.98-1.12) or postreform year 2 (combined medical conditions group: OR, 1.03; 95{\%} CI, 0.99-1.08; and combined surgical categories group: OR, 1.01; 95{\%} CI, 0.95-1.08) compared with the prereform years. The only condition for which there was a relative increase in mortality in more teaching-intensive hospitals postreform was stroke, but this association preceded the onset of duty hour reform. Compared with nonteaching hospitals, the most teaching-intensive hospitals had an absolute change in mortality from prereform year 1 to postreform year 2 of 0.42 percentage points (4.4{\%} relative increase) for patients in the combined medical conditions group and 0.05 percentage points (2.3{\%} relative increase) for patients in the combined surgical categories group, neither of which were statistically significant. Conclusion: The ACGME duty hour reform was not associated with either significant worsening or improvement in mortality for Medicare patients in the first 2 years after implementation.",
author = "Volpp, {Kevin G.} and Rosen, {Amy K.} and Rosenbaum, {Paul R.} and Romano, {Patrick S} and Orit Even-Shoshan and Yanli Wang and Lisa Bellini and Tiffany Behringer and Silber, {Jeffrey H.}",
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T1 - Mortality among hospitalized medicare beneficiaries in the first 2 years following ACGME resident duty hour reform

AU - Volpp, Kevin G.

AU - Rosen, Amy K.

AU - Rosenbaum, Paul R.

AU - Romano, Patrick S

AU - Even-Shoshan, Orit

AU - Wang, Yanli

AU - Bellini, Lisa

AU - Behringer, Tiffany

AU - Silber, Jeffrey H.

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N2 - Context: The Accreditation Council for Graduate Medical Education (ACGME) implemented duty hour regulations for physicians-in-training throughout the United States on July 1, 2003. The association of duty hour reform with mortality among patients in teaching hospitals nationally has not been well established. Objective: To determine whether the change in duty hour regulations was associated with relative changes in mortality among Medicare patients in hospitals of different teaching intensity. Design, Setting, and Patients: An observational study of all unique Medicare patients (N=8 529 595) admitted to short-term, acute-care, general US nonfederal hospitals (N=3321) using interrupted time series analysis with data from July 1, 2000, to June 30, 2005. All Medicare patients had principal diagnoses of acute myocardial infarction, congestive heart failure, gastrointestinal bleeding, or stroke or a diagnosis related group classification of general, orthopedic, or vascular surgery. Logistic regression was used to examine the change in mortality for patients in more vs less teaching-intensive hospitals before (academic years 2000-2003) and after (academic years 2003-2005) duty hour reform, adjusting for patient comorbidities, common time trends, and hospital site. Main Outcome Measure: All-location mortality within 30 days of hospital admission. Results: In medical and surgical patients, no significant relative increases or decreases in the odds of mortality for more vs less teaching-intensive hospitals were observed in either postreform year 1 (combined medical conditions group: odds ratio [OR], 1.03; 95% confidence interval [CI], 0.98-1.07; and combined surgical categories group: OR, 1.05; 95% CI, 0.98-1.12) or postreform year 2 (combined medical conditions group: OR, 1.03; 95% CI, 0.99-1.08; and combined surgical categories group: OR, 1.01; 95% CI, 0.95-1.08) compared with the prereform years. The only condition for which there was a relative increase in mortality in more teaching-intensive hospitals postreform was stroke, but this association preceded the onset of duty hour reform. Compared with nonteaching hospitals, the most teaching-intensive hospitals had an absolute change in mortality from prereform year 1 to postreform year 2 of 0.42 percentage points (4.4% relative increase) for patients in the combined medical conditions group and 0.05 percentage points (2.3% relative increase) for patients in the combined surgical categories group, neither of which were statistically significant. Conclusion: The ACGME duty hour reform was not associated with either significant worsening or improvement in mortality for Medicare patients in the first 2 years after implementation.

AB - Context: The Accreditation Council for Graduate Medical Education (ACGME) implemented duty hour regulations for physicians-in-training throughout the United States on July 1, 2003. The association of duty hour reform with mortality among patients in teaching hospitals nationally has not been well established. Objective: To determine whether the change in duty hour regulations was associated with relative changes in mortality among Medicare patients in hospitals of different teaching intensity. Design, Setting, and Patients: An observational study of all unique Medicare patients (N=8 529 595) admitted to short-term, acute-care, general US nonfederal hospitals (N=3321) using interrupted time series analysis with data from July 1, 2000, to June 30, 2005. All Medicare patients had principal diagnoses of acute myocardial infarction, congestive heart failure, gastrointestinal bleeding, or stroke or a diagnosis related group classification of general, orthopedic, or vascular surgery. Logistic regression was used to examine the change in mortality for patients in more vs less teaching-intensive hospitals before (academic years 2000-2003) and after (academic years 2003-2005) duty hour reform, adjusting for patient comorbidities, common time trends, and hospital site. Main Outcome Measure: All-location mortality within 30 days of hospital admission. Results: In medical and surgical patients, no significant relative increases or decreases in the odds of mortality for more vs less teaching-intensive hospitals were observed in either postreform year 1 (combined medical conditions group: odds ratio [OR], 1.03; 95% confidence interval [CI], 0.98-1.07; and combined surgical categories group: OR, 1.05; 95% CI, 0.98-1.12) or postreform year 2 (combined medical conditions group: OR, 1.03; 95% CI, 0.99-1.08; and combined surgical categories group: OR, 1.01; 95% CI, 0.95-1.08) compared with the prereform years. The only condition for which there was a relative increase in mortality in more teaching-intensive hospitals postreform was stroke, but this association preceded the onset of duty hour reform. Compared with nonteaching hospitals, the most teaching-intensive hospitals had an absolute change in mortality from prereform year 1 to postreform year 2 of 0.42 percentage points (4.4% relative increase) for patients in the combined medical conditions group and 0.05 percentage points (2.3% relative increase) for patients in the combined surgical categories group, neither of which were statistically significant. Conclusion: The ACGME duty hour reform was not associated with either significant worsening or improvement in mortality for Medicare patients in the first 2 years after implementation.

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