Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA
Massachusetts General Hospital, Boston, MA, USA.
BMJ. 2019 Jul 10;366:l4134. doi: 10.1136/bmj.l4134.
To determine whether 30 day mortality, 30 day readmissions, and inpatient spending vary according to whether physicians were exposed to work hour reforms during their residency.
Retrospective observational study.
US Medicare.
20% random sample (n=485 685) of Medicare beneficiaries aged 65 years or more admitted to hospital and treated by a general internist during 2000-12.
30 day mortality, 30 day readmissions, and inpatient Medicare Part B spending among patients treated by first year internists who were fully exposed to the 2003 Accreditation Council for Graduate Medical Education (ACGME) work hour reforms during their residency (completed residency after 2006) compared with first year internists with partial or no exposure to reforms (completed residency before 2006). Senior internists not exposed to reforms during their residency served as a control group (10th year internists) for general trends in hospital care: a difference-in-difference analysis.
Exposure of physicians to work hour reforms during their residency was not associated with statistically significant differences in 30 day mortality, 30 day readmissions, or inpatient spending. Among 485 685 hospital admissions, 30 day mortality rates during 2000-06 and 2007-12 for patients of first year internists were 10.6% (12 567 deaths/118 014 hospital admissions) and 9.6% (13 521/140 529), respectively, and for 10th year internists were 11.2% (11 018/98 811) and 10.6% (13 602/128 331), for an adjusted difference-in-difference effect of -0.1 percentage points (95% confidence interval -0.8% to 0.6%, P=0.68). 30 day readmission rates for first year internists during 2000-06 and 2007-12 were 20.4% (24 074/118 014) and 20.4% (28 689/140 529), respectively, and for 10th year internists were 20.1% (19 840/98 811) and 20.5% (26 277/128 331), for an adjusted difference-in-difference effect of 0.1 percentage points (-0.9% to 1.1%, P=0.87). Medicare Part B inpatient spending for first year internists during 2000-06 and 2007-12 was $1161 (£911; €1024) and $1267 per hospital admission, respectively, and for 10th year internists was $1331 and $1599, for an adjusted difference-in-difference effect of -$46 (95% confidence interval -$94 to $2, P=0.06).
Exposure of internists to work hour reforms during their residency was not associated with post-training differences in patient mortality, readmissions, or costs of care.
确定医生在住院医师培训期间是否接触工作时间改革，是否会导致 30 天死亡率、30 天再入院率和住院支出发生变化。
回顾性观察性研究。
美国医疗保险。
2000-12 年期间，年龄在 65 岁及以上、由普通内科医生治疗、并接受过 Medicare 治疗的患者的 20%随机样本（n=485685）。
接受完全接触 2003 年毕业后医学教育认证委员会（ACGME）工作时间改革的第一年住院医师（在 2006 年后完成住院医师培训）和部分或未接触改革的第一年住院医师（在 2006 年前完成住院医师培训）治疗的患者的 30 天死亡率、30 天再入院率和 Medicare 住院医师培训 B 部分支出。住院医师培训期间未接触改革的资深住院医师（第 10 年住院医师）作为医院护理一般趋势的对照组（差异分析）：差异在差异分析中。
医生在住院医师培训期间接触工作时间改革与 30 天死亡率、30 天再入院率或住院费用无统计学显著差异。在 485685 例住院患者中，2000-06 年和 2007-12 年第一年住院医师的患者 30 天死亡率分别为 10.6%（12567/118014 例住院）和 9.6%（13521/140529 例住院），第十年住院医师分别为 11.2%（11018/98811 例住院）和 10.6%（13602/128331 例住院），调整后的差异效应为-0.1 个百分点（95%置信区间-0.8%至 0.6%，P=0.68）。2000-06 年和 2007-12 年第一年住院医师的 30 天再入院率分别为 20.4%（24074/118014 例住院）和 20.4%（28689/140529 例住院），第十年住院医师的再入院率分别为 20.1%（19840/98811 例住院）和 20.5%（26277/128331 例住院），调整后的差异效应为 0.1 个百分点（-0.9%至 1.1%，P=0.87）。2000-06 年和 2007-12 年第一年住院医师的 Medicare 住院医师培训 B 部分住院费用分别为 1161 美元（911 英镑；1024 欧元）和 1267 美元/住院，第十年住院医师的住院费用分别为 1331 美元和 1599 美元，调整后的差异效应为-46 美元（95%置信区间-94 美元至 2 美元，P=0.06）。
住院医师在住院医师培训期间接触工作时间改革与培训后患者死亡率、再入院率或护理费用无差异。
