Effects of Resident Duty Hour Reform on Surgical and Procedural Patient Safety Indicators Among Hospitalized Veterans Health Administration and Medicare Patients
Open accessAbstract
OBJECTIVE: Improving patient safety was a strong motivation behind duty hour regulations implemented by Accreditation Council for Graduate Medical Education on July 1, 2003. We investigated whether rates of patient safety indicators (PSIs) changed after these reforms. RESEARCH DESIGN: Observational study of patients admitted to Veterans Health Administration (VA) (N = 826,047) and Medicare (N = 13,367,273) acute-care hospitals from July 1, 2000 to June 30, 2005. We examined changes in patient safety events in more versus less teaching-intensive hospitals before (2000-2003) and after (2003-2005) duty hour reform, using conditional logistic regression, adjusting for patient age, gender, comorbidities, secular trends, baseline severity, and hospital site. MEASURES: Ten PSIs were aggregated into 3 composite measures based on factor analyses: "Continuity of Care," "Technical Care," and "Other" composites. RESULTS: Continuity of Care composite rates showed no significant changes postreform in hospitals of different teaching intensity in either VA or Medicare. In the VA, there were no significant changes postreform for the technical care composite. In Medicare, the odds of a Technical Care PSI event in more versus less teaching-intensive hospitals in postreform year 1 were 1.12 (95% CI; 1.01-1.25); there were no significant relative changes in postreform year 2. Other composite rates increased in VA in postreform year 2 in more versus less teaching-intensive hospitals (odds ratio, 1.63; 95% CI; 1.10-2.41), but not in Medicare in either postreform year. CONCLUSIONS: Duty hour reform had no systematic impact on PSI rates. In the few cases where there were statistically significant increases in the relative odds of developing a PSI, the magnitude of the absolute increases were too small to be clinically meaningful.
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- Authors
- Rosen, A. K., Loveland, S. A., Romano, P. S., Itani, K. M. F., Silber, J. H., Even-Shoshan, O. O., Halenar, M. J., Teng, Y., Zhu, J., & Volpp, K. G.
- Affiliations
- Boston University (US)
- Leonard Davis Institute of Health Economics (US)
- Edith Nourse Rogers Memorial Veterans Hospital (US)
- Corresponding author
- Rosen, Amy K.
- Loveland, Susan A.
- Silber, Jeffrey H.
- Halenar, Michael J.
- Zhu, Jingsan
- Volpp, Kevin G.
- ORCID
- Venue
- Medical Care
- Published
- 2009-07
- Volume
- 47
- Issue
- 7
- Pages
- 723-731
- ISSN
- 0025-7079 (ISSN-L)
- PMC
- PMC3893754
- OpenAlex
- W2003257204
- Cited by
- 81
- References
- 43
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 1 · 2019: 3 · 2018: 5 · 2016: 5 · 2015: 4 · 2014: 8 · 2013: 13 · 2012: 15
- FWCI
- 12.94
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Medical Care (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Agency for Healthcare Research and Quality
- National Heart, Lung, and Blood Institute (R01HL082637, R0I HL082637)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Keywords
- patient safety indicators, surgical complications, procedural complications, teaching hospitals, continuity of care, technical care, Veterans Health Administration, Medicare, hospital quality, Accreditation Council for Graduate Medical Education
- MeSH terms
- Aged, Continuity of Patient Care, Factor Analysis, Statistical, Medicare, Health Services Research, Hospitals, Teaching, Hospitals, Veterans, Humans, Internship and Residency, Severity of Illness Index, United States, United States Department of Veterans Affairs, Logistic Models, Workload, Safety Management, Health Care Reform, Medical Errors, Quality Indicators, Health Care, Risk Adjustment
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