title: Teaching hospital financial status and patient outcomes following ACGME duty hour reform.
abstract: OBJECTIVE
  To examine whether hospital financial health was associated with differential changes in outcomes after implementation of 2003 ACGME duty hour regulations.
  
  
  METHODS
  Observational study of 3,614,174 Medicare patients admitted to 869 teaching hospitals from July 1, 2000 to June 30, 2005.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
authors.affiliation: Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA 19104, USA. amol@wharton.upenn.edu
authors.forename: Amol S
authors.initials: AS
authors.lastname: Navathe
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Silber
authors.forename: Dylan S
authors.initials: DS
authors.lastname: Small
authors.forename: Amy K
authors.initials: AK
authors.lastname: Rosen
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Romano
authors.forename: Orit
authors.initials: O
authors.lastname: Even-Shoshan
authors.forename: Yanli
authors.initials: Y
authors.lastname: Wang
authors.forename: Jingsan
authors.initials: J
authors.lastname: Zhu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Halenar
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Volpp
mesh_terms: D000367:Age Factors; D006302:Health Services Research; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000191:economics* / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D006801:Humans; D007396:Internship and Residency / Q000191:economics* / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D006278:Medicare / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010067:Ownership; D061214:Patient Safety; D010561:Personnel Staffing and Scheduling / Q000191:economics; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000191:economics / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States; D016270:United States Agency for Healthcare Research and Quality