Journal Article

The Impact of Resident Duty Hour Reform on Hospital Readmission Rates Among Medicare Beneficiaries

Press, Matthew J., Wang, Yanli, Rosen, Amy K., Romano, Patrick S., Zhu, Jingsan, Halenar, Michael J., Volpp, Kevin G., Itani, Kamal M. F., Even-Shoshan, Orit, Silber, Jeffrey H.

2011

Overview

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.

• Publisher: Springer-Verlag,Springer,Springer Nature B.V
• Subject: Biological and medical sciences / General aspects / Health education / Health participants / Humans / Internal Medicine / Internship and Residency - standards / Internship and Residency - trends / Medical residencies / Medical sciences / Medicare / Medicare - standards / Medicare - trends / Medicine / Medicine & Public Health / Miscellaneous / Occupational medicine / Original Research / Patient admissions / Patient Readmission - standards / Patient Readmission - trends / Personnel Staffing and Scheduling - standards / Personnel Staffing and Scheduling - trends / Public health. Hygiene / Public health. Hygiene-occupational medicine / Quality of Health Care - standards / Quality of Health Care - trends / United States / Work Schedule Tolerance / Working hours