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


METHODS
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.


METHODS
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).


METHODS
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.


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.
Department of Public Health, Weill Cornell Medical College, 402 E. 67th St., New York, NY 10065, USA. map9069@med.cornell.edu
Matthew J
MJ
Press
Jeffrey H
JH
Silber
Amy K
AK
Rosen
Patrick S
PS
Romano
Kamal M F
KM
Itani
Jingsan
J
Zhu
Yanli
Y
Wang
Orit
O
Even-Shoshan
Michael J
MJ
Halenar
Kevin G
KG
Volpp
D006801:Humans; D007396:Internship and Residency / Q000592:standards* / Q000639:trends; D006278:Medicare / Q000592:standards* / Q000639:trends; D010359:Patient Readmission / Q000592:standards* / Q000639:trends; D010561:Personnel Staffing and Scheduling / Q000592:standards* / Q000639:trends; D011787:Quality of Health Care / Q000592:standards* / Q000639:trends; D014481:United States; D014940:Work Schedule Tolerance