The impact of resident duty hour reform on hospital readmission rates Table 1. Characteristics of included hospitals Matth...
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The Impact of Resident Duty Hour Reform on Hospital Readmission Rates 10.27.09

Author: Matthew Press
Published on: Mar 4, 2016
Published in: Health & Medicine      
Source: www.slideshare.net


Transcripts - The Impact of Resident Duty Hour Reform on Hospital Readmission Rates 10.27.09

  • 1. The impact of resident duty hour reform on hospital readmission rates Table 1. Characteristics of included hospitals Matthew J. Press 1,2,3,4 , Jeffrey H. Silber 3,4,5,6 , Amy K. Rosen 7 , Patrick S. Romano 8 , Kamal M.F. Itani 9 , Lisa Bellini 3 , Jingsan Zhu 3 , Yanli Wang 6 , Orit Even-Shoshan 6 , Michael J. Halenar 2,3 , Kevin G. Volpp 2,3,4,5 1 Robert Wood Johnson Foundation Clinical Scholars Program; 2 CHERP, Philadelphia VAMC; 3 University of Pennsylvania School of Medicine; 4 Leonard Davis Institute of Health Economics, Philadelphia, PA; 5 The Wharton School, Philadelphia, PA; 6 Center for Outcomes Research, The Children's Hospital of Philadelphia; 7 Bedford VA and Boston University; 8 University of California, Davis; 9 Boston VA Funding for this work was provided in part by the grant NHLBI R01 HL082637. Note: For the outcomes readmission and readmission or post-discharge death, the total number of cases was 3,445,040 in the combined medical group and 4,404,154 in the combined surgical group. For the outcome readmission or 30-day mortality, the total number of cases was 3,759,711 in the combined medical group and 4,523,091 in the combined surgical group. Figure 1. Unadjusted trends in readmission rates, by hospital teaching intensity <ul><li>Observational study using interrupted time series analysis of all unique Medicare patients (N = 8,282,802) admitted to acute care hospitals with principal diagnoses of acute myocardial infarction, stroke, gastrointestinal bleed, congestive heart failure, or a DRG classification of general, orthopedic, or vascular surgery. </li></ul><ul><li>Fixed effects logistic regression to examine the change in the odds of readmission in more versus less teaching-intensive hospitals in the 3 years before and the 2 years after duty hour regulation went into effect (July 1, 2003). </li></ul><ul><li>Models are adjusted for age, sex, Elixhauser comorbidities, common time trends, admission source, and hospital site where treated. </li></ul><ul><li>Outcomes are 30-day all-cause readmission, readmission or post-discharge death, and readmission or mortality within 30 days of admission. </li></ul>Methods <ul><li>A key goal of duty hour regulation by the ACGME was to improve hospital outcomes. </li></ul><ul><li>Critics were concerned that outcomes would worsen after implementation of the new rules. </li></ul><ul><li>Earlier work demonstrated that overall mortality did not worsen after the reform and slightly improved in certain subgroups. </li></ul><ul><li>Other work showed no improvement or worsening for the following measures: mortality for high-risk patients, failure-to-rescue, patient safety indicators, and prolonged hospital stay. </li></ul><ul><li>Readmissions are a common, costly, and increasingly utilized indicator of quality of care that may have been influenced by the continuity of care implications of resident duty hour reform. </li></ul><ul><li>The impact of duty hour reform on hospital readmission rates is unknown. </li></ul>Background <ul><li>To assess whether resident duty hour reform led to a relative improvement or worsening of readmission rates among Medicare patients in hospitals of different teaching intensity. </li></ul>Objective Table 2. Unadjusted 30-day all-cause readmission rates by year (%) Results Table 3. Adjusted odds of readmission after duty hour reform in more vs. less teaching-intensive hospitals Results <ul><li>Hospital readmission rates neither improved nor worsened in association with ACGME duty hour reform. </li></ul><ul><li>These findings were robust to the use of composite measures of readmission and mortality. </li></ul>Conclusions <ul><li>Evidence to date suggests that resident duty hour reform did not generally improve or worsen patient outcomes. </li></ul><ul><li>Current deliberations on further reform should factor in these findings. </li></ul><ul><li>Future work utilizing hospital readmissions should consider composite measures of readmission and mortality. </li></ul>Policy Implications

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