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Teaching Hospital Financial Status and Patient Outcomes Following ACGME Duty Hour Reform

Authors

  • Amol S. Navathe,

    Corresponding author
    1. Department of Medicine, School of Medicine, The University of Pennsylvania, Philadelphia, PA
    2. Department of Health Care Management and Economics, The Wharton School, The University of Pennsylvania, Philadelphia, PA
    3. Brigham and Women's Hospital, Harvard Medical School, Boston, MA
    • Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
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  • Jeffrey H. Silber,

    1. Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
    2. Department of Health Care Management and Economics, The Wharton School, The University of Pennsylvania, Philadelphia, PA
    3. Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
    4. Departments of Pediatrics and Anesthesiology and Critical Care, School of Medicine, The University of Pennsylvania, Philadelphia, PA
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  • Dylan S. Small,

    1. Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
    2. Department of Statistics, The Wharton School, The University of Pennsylvania, Philadelphia, PA
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  • Amy K. Rosen,

    1. Department of Health Policy and Management, Boston University School of Public Health, Boston, MA
    2. Center for Organization, Leadership and Management Research, Veteran's Administration Hospital, Boston, MA
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  • Patrick S. Romano,

    1. Division of General Medicine and Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, CA
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  • Orit Even-Shoshan,

    1. Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
    2. Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
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  • Yanli Wang,

    1. Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
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  • Jingsan Zhu,

    1. Department of Medicine, School of Medicine, The University of Pennsylvania, Philadelphia, PA
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  • Michael J. Halenar,

    1. Department of Medicine, School of Medicine, The University of Pennsylvania, Philadelphia, PA
    2. Center for Health Equity Research and Promotion, Veteran's Administration Hospital, Philadelphia, PA
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  • Kevin G. Volpp

    1. Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
    2. Department of Medicine, School of Medicine, The University of Pennsylvania, Philadelphia, PA
    3. Department of Health Care Management and Economics, The Wharton School, The University of Pennsylvania, Philadelphia, PA
    4. Center for Health Equity Research and Promotion, Veteran's Administration Hospital, Philadelphia, PA
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Address correspondence to Amol S. Navathe, M.D., Ph.D., Leonard Davis Institute of Health Economics, The University of Pennsylvania, 3641 Locust Walk, Room 202, Philadelphia, PA 19104, e-mail: amol@wharton.upenn.edu.

Abstract

Objective

To examine whether hospital financial health was associated with differential changes in outcomes after implementation of 2003 ACGME duty hour regulations.

Data Sources/Study Setting

Observational study of 3,614,174 Medicare patients admitted to 869 teaching hospitals from July 1, 2000 to June 30, 2005.

Study Design

Interrupted time series analysis using logistic regression to adjust for patient comorbidities, secular trends, and hospital site. Outcomes included 30-day mortality, AHRQ Patient Safety Indicators (PSIs), failure-to-rescue (FTR) rates, and prolonged length of stay (PLOS).

Principal Findings

All eight analyses measuring the impact of duty hour reform on mortality by hospital financial health quartile, in postreform year 1 (“Post 1”) or year 2 (“Post 2”) versus the prereform period, were insignificant: Post 1 OR range 1.00–1.02 and Post 2 OR range 0.99–1.02. For PSIs, all six tests showed clinically insignificant effect sizes. The FTR rate analysis demonstrated nonsignificance in both postreform years (OR 1.00 for both). The PLOS outcomes varied significantly only for the combined surgical sample in Post 2, but this effect was very small, OR 1.03 (95% CI 1.02, 1.04).

Conclusions

The impact of 2003 ACGME duty hour reform on patient outcomes did not differ by hospital financial health. This finding is somewhat reassuring, given additional financial pressure on teaching hospitals from 2011 duty hour regulations.

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