Teaching hospital five-year mortality trends in the wake of duty hour reforms

Kevin G. Volpp, Dylan S. Small, Patrick S Romano, Kamal M F Itani, Amy K. Rosen, Orit Even-Shoshan, Yanli Wang, Lisa Bellini, Michael J. Halenar, Sophia Korovaichuk, Jingsan Zhu, Jeffrey H. Silber

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1048-1055
Number of pages8
JournalJournal of General Internal Medicine
Volume28
Issue number8
DOIs
StatePublished - Aug 2013

Fingerprint

Teaching Hospitals
Mortality
Medicare
Graduate Medical Education
Accreditation
Diagnosis-Related Groups
Observational Studies
Orthopedics
Blood Vessels
Comorbidity
Heart Failure
Logistic Models
Myocardial Infarction
Hemorrhage

Keywords

  • ACGME
  • administrative data
  • duty hour reform
  • mortality
  • patient outcomes

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Volpp, K. G., Small, D. S., Romano, P. S., Itani, K. M. F., Rosen, A. K., Even-Shoshan, O., ... Silber, J. H. (2013). Teaching hospital five-year mortality trends in the wake of duty hour reforms. Journal of General Internal Medicine, 28(8), 1048-1055. https://doi.org/10.1007/s11606-013-2401-9

Teaching hospital five-year mortality trends in the wake of duty hour reforms. / Volpp, Kevin G.; Small, Dylan S.; Romano, Patrick S; Itani, Kamal M F; Rosen, Amy K.; Even-Shoshan, Orit; Wang, Yanli; Bellini, Lisa; Halenar, Michael J.; Korovaichuk, Sophia; Zhu, Jingsan; Silber, Jeffrey H.

In: Journal of General Internal Medicine, Vol. 28, No. 8, 08.2013, p. 1048-1055.

Research output: Contribution to journalArticle

Volpp, KG, Small, DS, Romano, PS, Itani, KMF, Rosen, AK, Even-Shoshan, O, Wang, Y, Bellini, L, Halenar, MJ, Korovaichuk, S, Zhu, J & Silber, JH 2013, 'Teaching hospital five-year mortality trends in the wake of duty hour reforms', Journal of General Internal Medicine, vol. 28, no. 8, pp. 1048-1055. https://doi.org/10.1007/s11606-013-2401-9
Volpp, Kevin G. ; Small, Dylan S. ; Romano, Patrick S ; Itani, Kamal M F ; Rosen, Amy K. ; Even-Shoshan, Orit ; Wang, Yanli ; Bellini, Lisa ; Halenar, Michael J. ; Korovaichuk, Sophia ; Zhu, Jingsan ; Silber, Jeffrey H. / Teaching hospital five-year mortality trends in the wake of duty hour reforms. In: Journal of General Internal Medicine. 2013 ; Vol. 28, No. 8. pp. 1048-1055.
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abstract = "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.",
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AU - Romano, Patrick S

AU - Itani, Kamal M F

AU - Rosen, Amy K.

AU - Even-Shoshan, Orit

AU - Wang, Yanli

AU - Bellini, Lisa

AU - Halenar, Michael J.

AU - Korovaichuk, Sophia

AU - Zhu, Jingsan

AU - Silber, Jeffrey H.

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N2 - 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.

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