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Med Care. 2009 Dec;47(12):1191-200. doi: 10.1097/MLR.0b013e3181adcbff.

Prolonged hospital stay and the resident duty hour rules of 2003.

Author information

1
Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. silberj@wharton.upenn.edu

Abstract

BACKGROUND:

Resident duty hour reforms of 2003 had the potential to create a major impact on the delivery of inpatient care.

OBJECTIVE:

We examine whether the reforms influenced the probability of a patient experiencing a prolonged hospital length of stay (PLOS), a measure reflecting either inefficiency of care or the development of complications that may slow the rate of discharge.

RESEARCH DESIGN:

Conditional logistic models to compare PLOS in more versus less teaching-intensive hospitals before and after the reform, adjusting for patient comorbidities, common time trends, and hospital site.

SUBJECTS:

Medicare (N = 6,059,015) and Veterans Affairs (VA) (N = 210,276) patients admitted for medical conditions (acute myocardial infarction, heart failure, stroke, or gastrointestinal bleeding) or surgical procedures (general, orthopedic, and vascular) from July 2000 to June 2005.

MEASURES:

Prolonged length of stay.

RESULTS:

Modeling all medical conditions together, the odds of prolonged stay in the first year post reform at more versus less teaching intensive hospitals was 1.01 (95% CI: 0.97-1.05) for Medicare and 1.07 (0.94-1.20) for the VA. Results were similarly negative in the second year post reform. For "combined surgery" the post year 1 odds ratios were 1.04 (0.98-1.09) and 0.94 (0.78-1.14) for Medicare and the VA respectively, and similarly unchanged in post year 2. Isolated increases in the probability of prolonged stay did occur for some vascular surgery procedures.

CONCLUSIONS:

Hospitals generally found ways to cope with duty hour reform without increasing the prevalence of prolonged hospital stays, a marker of either inefficient care or complications.

Comment in

PMID:
19786912
PMCID:
PMC3279179
DOI:
10.1097/MLR.0b013e3181adcbff
[Indexed for MEDLINE]
Free PMC Article

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