The impact of resident duty hour reform on hospital readmission rates among medicare beneficiaries

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

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: A key goal of resident duty hour reform by the Accreditation Council for Graduate Medical Education (ACGME) in 2003 was to improve patient outcomes. Objective: To assess whether the reform led to a change in readmission rates. Design: Observational study using multiple time series analysis with hospital discharge data from July 1, 2000 to June 30, 2005. Fixed effects logistic regression was used to examine the change in the odds of readmission in more versus less teaching-intensive hospitals before and after duty hour reform. Participants: All unique Medicare patients (n=8,282,802) admitted to acute-care nonfederal hospitals with principal diagnoses of acute myocardial infarction, congestive heart failure, gastrointestinal bleeding, or stroke (combined medical group), or a DRG classification of general, orthopedic, or vascular surgery (combined surgical group). Main measures: Primary outcome was 30-day all-cause readmission. Secondary outcomes were (1) readmission or death within 30 days of discharge, and (2) readmission, death during the index admission, or death within 30 days of discharge. Key Results: For the combined medical group, there was no evidence of a change in readmission rates in more versus less teaching-intensive hospitals [OR = 0.99 (95% CI 0.94, 1.03) in post-reform year 1 and OR = 0.99 (95% CI 0.95, 1.04) in post-reform year 2]. There was also no evidence of relative changes in readmission rates for the combined surgical group: OR = 1.03 (95% CI 0.98, 1.08) for post-reform year 1 and OR = 1.02 (95% CI 0.98, 1.07) for post-reform year 2. Findings for the secondary outcomes combining readmission and death were similar. Conclusions: Among Medicare beneficiaries, there were no changes in hospital readmission rates associated with resident duty hour reform.

Original languageEnglish (US)
Pages (from-to)405-411
Number of pages7
JournalJournal of General Internal Medicine
Volume26
Issue number4
DOIs
StatePublished - Apr 2011

Fingerprint

Patient Readmission
Medicare
Teaching Hospitals
Graduate Medical Education
Accreditation
Diagnosis-Related Groups
Observational Studies
Orthopedics
Blood Vessels
Heart Failure
Logistic Models
Stroke
Myocardial Infarction
Outcome Assessment (Health Care)
Hemorrhage

Keywords

  • education, medical, graduate
  • hospital
  • readmission

ASJC Scopus subject areas

  • Internal Medicine

Cite this

The impact of resident duty hour reform on hospital readmission rates among medicare beneficiaries. / Press, Matthew J.; Silber, Jeffrey H.; Rosen, Amy K.; Romano, Patrick S; Itani, Kamal M F; Zhu, Jingsan; Wang, Yanli; Even-Shoshan, Orit; Halenar, Michael J.; Volpp, Kevin G.

In: Journal of General Internal Medicine, Vol. 26, No. 4, 04.2011, p. 405-411.

Research output: Contribution to journalArticle

Press, MJ, Silber, JH, Rosen, AK, Romano, PS, Itani, KMF, Zhu, J, Wang, Y, Even-Shoshan, O, Halenar, MJ & Volpp, KG 2011, 'The impact of resident duty hour reform on hospital readmission rates among medicare beneficiaries', Journal of General Internal Medicine, vol. 26, no. 4, pp. 405-411. https://doi.org/10.1007/s11606-010-1539-y
Press, Matthew J. ; Silber, Jeffrey H. ; Rosen, Amy K. ; Romano, Patrick S ; Itani, Kamal M F ; Zhu, Jingsan ; Wang, Yanli ; Even-Shoshan, Orit ; Halenar, Michael J. ; Volpp, Kevin G. / The impact of resident duty hour reform on hospital readmission rates among medicare beneficiaries. In: Journal of General Internal Medicine. 2011 ; Vol. 26, No. 4. pp. 405-411.
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abstract = "Background: A key goal of resident duty hour reform by the Accreditation Council for Graduate Medical Education (ACGME) in 2003 was to improve patient outcomes. Objective: To assess whether the reform led to a change in readmission rates. Design: Observational study using multiple time series analysis with hospital discharge data from July 1, 2000 to June 30, 2005. Fixed effects logistic regression was used to examine the change in the odds of readmission in more versus less teaching-intensive hospitals before and after duty hour reform. Participants: All unique Medicare patients (n=8,282,802) admitted to acute-care nonfederal hospitals with principal diagnoses of acute myocardial infarction, congestive heart failure, gastrointestinal bleeding, or stroke (combined medical group), or a DRG classification of general, orthopedic, or vascular surgery (combined surgical group). Main measures: Primary outcome was 30-day all-cause readmission. Secondary outcomes were (1) readmission or death within 30 days of discharge, and (2) readmission, death during the index admission, or death within 30 days of discharge. Key Results: For the combined medical group, there was no evidence of a change in readmission rates in more versus less teaching-intensive hospitals [OR = 0.99 (95{\%} CI 0.94, 1.03) in post-reform year 1 and OR = 0.99 (95{\%} CI 0.95, 1.04) in post-reform year 2]. There was also no evidence of relative changes in readmission rates for the combined surgical group: OR = 1.03 (95{\%} CI 0.98, 1.08) for post-reform year 1 and OR = 1.02 (95{\%} CI 0.98, 1.07) for post-reform year 2. Findings for the secondary outcomes combining readmission and death were similar. Conclusions: Among Medicare beneficiaries, there were no changes in hospital readmission rates associated with resident duty hour reform.",
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