Hunt Maya L, Chung Jeanette W, Hu Yue-Yung, Bilimoria Karl Y, Holmstrom Amy L
is a PGY-4 Resident, Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
is a Senior Research Professor, SOQIC, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
J Grad Med Educ. 2025 Aug;17(4):486-496. doi: 10.4300/JGME-D-24-00960.1. Epub 2025 Aug 15.
In 2017, the Accreditation Council for Graduate Medical Education (ACGME) updated select US residency duty hour requirements to improve continuity of care and resident education. It is unknown if this policy change affected hospital quality of care and patient experience. To evaluate the association of the 2017 duty hour policy change with hospital quality and patient experience in teaching vs nonteaching hospitals. In this observational difference-in-differences (DiD) study, hospital quality (patient outcomes) and patient experience metrics were obtained from Centers for Medicare & Medicaid Services data from before (July 1, 2014-June 30, 2016) and after (July 1, 2017-June 30, 2019) the 2017 policy change in teaching and nonteaching hospitals. Primary outcomes include hospital quality (five 30-day readmission indicator rates, five 30-day mortality rates, 8 patient safety indicators), and patient experience (5 measures from Hospital Consumer Assessment of Healthcare Providers and Systems survey). A total of 2935 hospitals (250 teaching; 2685 nonteaching) were included. When comparing before and after the 2017 policy change, teaching hospitals had greater reductions in hospital-wide readmission (DiD coefficient -0.26; 95% CI, -0.34 to -0.18; <.001), heart failure readmission (DiD coefficient -0.48; 95% CI, -0.78 to -0.19; <.002), and stroke mortality rates (DiD coefficient -0.56; 95% CI, -0.94 to -0.19; <.01) than did nonteaching hospitals. There were no significant differences between teaching and nonteaching hospitals in other outcomes before vs after policy change. After the 2017 duty hour policy change, there was no evidence of worsening of hospital quality or patient experience in teaching hospitals, compared to nonteaching hospitals.
2017年，毕业后医学教育认证委员会（ACGME）更新了美国部分住院医师值班时长要求，以改善医疗服务的连续性和住院医师教育。尚不清楚这一政策变化是否影响了医院的医疗质量和患者体验。为了评估2017年值班时长政策变化与教学医院和非教学医院的医院质量及患者体验之间的关联。在这项观察性差异-差异（DiD）研究中，医院质量（患者结局）和患者体验指标取自医疗保险和医疗补助服务中心在2017年政策变化之前（2014年7月1日至2016年6月30日）和之后（2017年7月1日至2019年6月30日）的教学医院和非教学医院的数据。主要结局包括医院质量（五个30天再入院指标率、五个30天死亡率、8个患者安全指标）和患者体验（来自医疗服务提供者和系统消费者评估调查的5项指标）。共纳入2935家医院（250家教学医院；2685家非教学医院）。在比较2017年政策变化前后时，教学医院在全院再入院率（DiD系数-0.26；95%CI，-0.34至-0.18；<.001）、心力衰竭再入院率（DiD系数-0.48；95%CI，-0.78至-0.19；<.002）和卒中死亡率（DiD系数-0.56；95%CI，-0.94至-0.19；<.01）方面的降幅大于非教学医院。在政策变化前后，教学医院和非教学医院在其他结局方面没有显著差异。2017年值班时长政策变化后，与非教学医院相比，没有证据表明教学医院的医院质量或患者体验恶化。
