Prolonged hospital stay and the resident duty hour rules of 2003

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

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

BACKGROUND: Resident duty hour reforms of 2003 had the potential to create a major impact on the delivery of inpatient care. OBJECTIVE: We examine whether the reforms influenced the probability of a patient experiencing a prolonged hospital length of stay (PLOS), a measure reflecting either inefficiency of care or the development of complications that may slow the rate of discharge. RESEARCH DESIGN: Conditional logistic models to compare PLOS in more versus less teaching-intensive hospitals before and after the reform, adjusting for patient comorbidities, common time trends, and hospital site. SUBJECTS: Medicare (N = 6,059,015) and Veterans Affairs (VA) (N = 210,276) patients admitted for medical conditions (acute myocardial infarction, heart failure, stroke, or gastrointestinal bleeding) or surgical procedures (general, orthopedic, and vascular) from July 2000 to June 2005. MEASURES: Prolonged length of stay. RESULTS: Modeling all medical conditions together, the odds of prolonged stay in the first year post reform at more versus less teaching intensive hospitals was 1.01 (95% CI: 0.97-1.05) for Medicare and 1.07 (0.94-1.20) for the VA. Results were similarly negative in the second year post reform. For "combined surgery" the post year 1 odds ratios were 1.04 (0.98-1.09) and 0.94 (0.78-1.14) for Medicare and the VA respectively, and similarly unchanged in post year 2. Isolated increases in the probability of prolonged stay did occur for some vascular surgery procedures. CONCLUSIONS: Hospitals generally found ways to cope with duty hour reform without increasing the prevalence of prolonged hospital stays, a marker of either inefficient care or complications.

Original languageEnglish (US)
Pages (from-to)1191-1200
Number of pages10
JournalMedical Care
Volume47
Issue number12
DOIs
StatePublished - Dec 2009

Fingerprint

Length of Stay
Veterans
Medicare
Teaching Hospitals
Vascular Surgical Procedures
Orthopedic Procedures
Blood Vessels
Comorbidity
Inpatients
Heart Failure
Logistic Models
Stroke
Odds Ratio
Myocardial Infarction
Hemorrhage

Keywords

  • Difference-in-differences
  • Prolonged length of stay
  • Teaching hospitals

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Silber, J. H., Rosenbaum, P. R., Rosen, A. K., Romano, P. S., Itani, K. M. F., Cen, L., ... Volpp, K. G. (2009). Prolonged hospital stay and the resident duty hour rules of 2003. Medical Care, 47(12), 1191-1200. https://doi.org/10.1097/MLR.0b013e3181adcbff

Prolonged hospital stay and the resident duty hour rules of 2003. / Silber, Jeffrey H.; Rosenbaum, Paul R.; Rosen, Amy K.; Romano, Patrick S; Itani, Kamal M F; Cen, Liyi; Mi, Lanyu; Halenar, Michael J.; Even-Shoshan, Orit; Volpp, Kevin G.

In: Medical Care, Vol. 47, No. 12, 12.2009, p. 1191-1200.

Research output: Contribution to journalArticle

Silber, JH, Rosenbaum, PR, Rosen, AK, Romano, PS, Itani, KMF, Cen, L, Mi, L, Halenar, MJ, Even-Shoshan, O & Volpp, KG 2009, 'Prolonged hospital stay and the resident duty hour rules of 2003', Medical Care, vol. 47, no. 12, pp. 1191-1200. https://doi.org/10.1097/MLR.0b013e3181adcbff
Silber JH, Rosenbaum PR, Rosen AK, Romano PS, Itani KMF, Cen L et al. Prolonged hospital stay and the resident duty hour rules of 2003. Medical Care. 2009 Dec;47(12):1191-1200. https://doi.org/10.1097/MLR.0b013e3181adcbff
Silber, Jeffrey H. ; Rosenbaum, Paul R. ; Rosen, Amy K. ; Romano, Patrick S ; Itani, Kamal M F ; Cen, Liyi ; Mi, Lanyu ; Halenar, Michael J. ; Even-Shoshan, Orit ; Volpp, Kevin G. / Prolonged hospital stay and the resident duty hour rules of 2003. In: Medical Care. 2009 ; Vol. 47, No. 12. pp. 1191-1200.
@article{71f665af3c5f4d149511c1792f441c7d,
title = "Prolonged hospital stay and the resident duty hour rules of 2003",
abstract = "BACKGROUND: Resident duty hour reforms of 2003 had the potential to create a major impact on the delivery of inpatient care. OBJECTIVE: We examine whether the reforms influenced the probability of a patient experiencing a prolonged hospital length of stay (PLOS), a measure reflecting either inefficiency of care or the development of complications that may slow the rate of discharge. RESEARCH DESIGN: Conditional logistic models to compare PLOS in more versus less teaching-intensive hospitals before and after the reform, adjusting for patient comorbidities, common time trends, and hospital site. SUBJECTS: Medicare (N = 6,059,015) and Veterans Affairs (VA) (N = 210,276) patients admitted for medical conditions (acute myocardial infarction, heart failure, stroke, or gastrointestinal bleeding) or surgical procedures (general, orthopedic, and vascular) from July 2000 to June 2005. MEASURES: Prolonged length of stay. RESULTS: Modeling all medical conditions together, the odds of prolonged stay in the first year post reform at more versus less teaching intensive hospitals was 1.01 (95{\%} CI: 0.97-1.05) for Medicare and 1.07 (0.94-1.20) for the VA. Results were similarly negative in the second year post reform. For {"}combined surgery{"} the post year 1 odds ratios were 1.04 (0.98-1.09) and 0.94 (0.78-1.14) for Medicare and the VA respectively, and similarly unchanged in post year 2. Isolated increases in the probability of prolonged stay did occur for some vascular surgery procedures. CONCLUSIONS: Hospitals generally found ways to cope with duty hour reform without increasing the prevalence of prolonged hospital stays, a marker of either inefficient care or complications.",
keywords = "Difference-in-differences, Prolonged length of stay, Teaching hospitals",
author = "Silber, {Jeffrey H.} and Rosenbaum, {Paul R.} and Rosen, {Amy K.} and Romano, {Patrick S} and Itani, {Kamal M F} and Liyi Cen and Lanyu Mi and Halenar, {Michael J.} and Orit Even-Shoshan and Volpp, {Kevin G.}",
year = "2009",
month = "12",
doi = "10.1097/MLR.0b013e3181adcbff",
language = "English (US)",
volume = "47",
pages = "1191--1200",
journal = "Medical Care",
issn = "0025-7079",
publisher = "Lippincott Williams and Wilkins",
number = "12",

}

TY - JOUR

T1 - Prolonged hospital stay and the resident duty hour rules of 2003

AU - Silber, Jeffrey H.

AU - Rosenbaum, Paul R.

AU - Rosen, Amy K.

AU - Romano, Patrick S

AU - Itani, Kamal M F

AU - Cen, Liyi

AU - Mi, Lanyu

AU - Halenar, Michael J.

AU - Even-Shoshan, Orit

AU - Volpp, Kevin G.

PY - 2009/12

Y1 - 2009/12

N2 - BACKGROUND: Resident duty hour reforms of 2003 had the potential to create a major impact on the delivery of inpatient care. OBJECTIVE: We examine whether the reforms influenced the probability of a patient experiencing a prolonged hospital length of stay (PLOS), a measure reflecting either inefficiency of care or the development of complications that may slow the rate of discharge. RESEARCH DESIGN: Conditional logistic models to compare PLOS in more versus less teaching-intensive hospitals before and after the reform, adjusting for patient comorbidities, common time trends, and hospital site. SUBJECTS: Medicare (N = 6,059,015) and Veterans Affairs (VA) (N = 210,276) patients admitted for medical conditions (acute myocardial infarction, heart failure, stroke, or gastrointestinal bleeding) or surgical procedures (general, orthopedic, and vascular) from July 2000 to June 2005. MEASURES: Prolonged length of stay. RESULTS: Modeling all medical conditions together, the odds of prolonged stay in the first year post reform at more versus less teaching intensive hospitals was 1.01 (95% CI: 0.97-1.05) for Medicare and 1.07 (0.94-1.20) for the VA. Results were similarly negative in the second year post reform. For "combined surgery" the post year 1 odds ratios were 1.04 (0.98-1.09) and 0.94 (0.78-1.14) for Medicare and the VA respectively, and similarly unchanged in post year 2. Isolated increases in the probability of prolonged stay did occur for some vascular surgery procedures. CONCLUSIONS: Hospitals generally found ways to cope with duty hour reform without increasing the prevalence of prolonged hospital stays, a marker of either inefficient care or complications.

AB - BACKGROUND: Resident duty hour reforms of 2003 had the potential to create a major impact on the delivery of inpatient care. OBJECTIVE: We examine whether the reforms influenced the probability of a patient experiencing a prolonged hospital length of stay (PLOS), a measure reflecting either inefficiency of care or the development of complications that may slow the rate of discharge. RESEARCH DESIGN: Conditional logistic models to compare PLOS in more versus less teaching-intensive hospitals before and after the reform, adjusting for patient comorbidities, common time trends, and hospital site. SUBJECTS: Medicare (N = 6,059,015) and Veterans Affairs (VA) (N = 210,276) patients admitted for medical conditions (acute myocardial infarction, heart failure, stroke, or gastrointestinal bleeding) or surgical procedures (general, orthopedic, and vascular) from July 2000 to June 2005. MEASURES: Prolonged length of stay. RESULTS: Modeling all medical conditions together, the odds of prolonged stay in the first year post reform at more versus less teaching intensive hospitals was 1.01 (95% CI: 0.97-1.05) for Medicare and 1.07 (0.94-1.20) for the VA. Results were similarly negative in the second year post reform. For "combined surgery" the post year 1 odds ratios were 1.04 (0.98-1.09) and 0.94 (0.78-1.14) for Medicare and the VA respectively, and similarly unchanged in post year 2. Isolated increases in the probability of prolonged stay did occur for some vascular surgery procedures. CONCLUSIONS: Hospitals generally found ways to cope with duty hour reform without increasing the prevalence of prolonged hospital stays, a marker of either inefficient care or complications.

KW - Difference-in-differences

KW - Prolonged length of stay

KW - Teaching hospitals

UR - http://www.scopus.com/inward/record.url?scp=73349143632&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=73349143632&partnerID=8YFLogxK

U2 - 10.1097/MLR.0b013e3181adcbff

DO - 10.1097/MLR.0b013e3181adcbff

M3 - Article

VL - 47

SP - 1191

EP - 1200

JO - Medical Care

JF - Medical Care

SN - 0025-7079

IS - 12

ER -