Introduction In 2011, the Accreditation Council for Graduate Medical Education (ACGME) expanded restrictions on resident duty hours. While studies have shown no association between these restrictions and improved outcomes, process-of-care and patient experience measures may be more sensitive to resident performance, and thus may be impacted by duty hour policies. The objective of this study was to evaluate the association between the 2011 resident duty hour reform and measures of processes-of-care and patient experience.
Methods Hospital Consumer Assessment of Healthcare Providers and Systems survey data and process-of-care scores were obtained from the Centers for Medicare and Medicaid Services Hospital Compare website for 1 year prior to (1 July 2010 to 30 June 2011) and 1 year after (1 July 2011 to 30 June 2012) duty hour reform implementation. Using a difference-in-differences model, non-teaching and teaching hospitals were compared before and after the 2011 reform to test the association of this policy with changes in process-of-care and patient experience measure scores.
Results Duty hour reform was not associated with a change in the five patient experience measures evaluated, including patients rating a hospital 9 or 10 (coefficient −0.003, 95% CI −0.79 to 0.79) or stating they would ‘definitely recommend’ a hospital (coefficient −0.28, 95% CI −1.01 to 0.44). For all 10 process-of-care measures examined, such as antibiotic timing (coefficient −0.462, 95% CI −1.502 to 0.579) and discontinuation (0.188, 95% CI −0.529 to 0.904), duty hour reform was not associated with a change in scores.
Conclusions The 2011 ACGME duty hour reform was not associated with improvements in process-of-care and patient experience measures. These data should be considered when considering reform of resident duty hour policies.
- Duty hours
- Patient safety
- Quality improvement
- Graduate medical education
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Contributors Study concept and design was completed by all authors. RR, JC, KYB and AD were responsible for acquisition, statistical analysis and interpretation of data. Drafting of the manuscript was completed by RR, KYB and LS. Revision of the manuscript was completed by all authors. Study supervision and funding was provided by KYB.
Funding American College of Surgeons, Agency for Healthcare Research and Quality (#T32HS000078); an unrestricted educational grant from Merck.
Competing interests KYB reported support from the National Institutes of Health, Agency for Healthcare Research and Quality, American Board of Surgery, American College of Surgeons, Accreditation Council for Graduate Medical Education, National Comprehensive Cancer Network, American Cancer Society, Health Care Services Corporation, California Health Care Foundation, Northwestern University, the Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Foundation, and Northwestern Memorial Hospital. KYB has received honoraria from hospitals, professional societies, and continuing medical education companies for clinical care and quality improvement research presentations.
Provenance and peer review Not commissioned; externally peer reviewed.