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Published in:

01-04-2011 | Original Research

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

Authors: Matthew J. Press, MD, MS, Jeffrey H. Silber, MD, PhD, Amy K. Rosen, PhD, Patrick S. Romano, MD, MPH, Kamal M. F. Itani, MD, Jingsan Zhu, MBA, Yanli Wang, MS, Orit Even-Shoshan, MS, Michael J. Halenar, BA, Kevin G. Volpp, MD, PhD

Published in: Journal of General Internal Medicine | Issue 4/2011

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.

Available only for authorised users

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Title: The Impact of Resident Duty Hour Reform on Hospital Readmission Rates Among Medicare Beneficiaries
Authors: Matthew J. Press, MD, MS
Jeffrey H. Silber, MD, PhD
Amy K. Rosen, PhD
Patrick S. Romano, MD, MPH
Kamal M. F. Itani, MD
Jingsan Zhu, MBA
Yanli Wang, MS
Orit Even-Shoshan, MS
Michael J. Halenar, BA
Kevin G. Volpp, MD, PhD
Publication date: 01-04-2011
Publisher: Springer-Verlag
Published in: Journal of General Internal Medicine / Issue 4/2011
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-010-1539-y

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ABSTRACT

Background

Objective

Design

Participants

Main measures

Key Results

Conclusions

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