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J Gen Intern Med. 2012 Feb;27(2):241-9. doi: 10.1007/s11606-011-1775-9. Epub 2011 Jul 21.

Cost implications of ACGME's 2011 changes to resident duty hours and the training environment.

Author information

1
Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, 911 Broxton Avenue, Los Angeles, CA 90095, USA. tnuckols@mednet.ucla.edu

Erratum in

  • J Gen Intern Med. 2012 Feb;27(2):262-3.

Abstract

BACKGROUND:

In July 2011, the Accreditation Council for Graduate Medical Education (ACGME) will implemented stricter duty-hour limits and related changes to the training environment. This may affect preventable adverse event (PAE) rates.

OBJECTIVES:

To estimate direct costs under various implementation approaches, and examine net costs to teaching hospitals and cost-effectiveness to society across a range of hypothetical changes in PAEs.

DESIGN:

A decision-analytical model represented direct costs and PAE rates, mortality, and costs.

DATA SOURCES:

Published literature and publicly available data.

TARGET POPULATION:

Patients admitted to hospitals with ACGME-accredited programs.

TIME HORIZON:

One year.

PERSPECTIVES:

All teaching hospitals, major teaching hospitals, society.

INTERVENTION:

ACGME's 2011 Common Program Requirements.

OUTCOME MEASURES:

Direct annual costs (all accredited hospitals), net cost (major teaching hospitals), cost per death averted (society). RESULTS OF BASE-ANALYSIS: Nationwide, duty-hour changes would cost $177 million annually if interns maintain current productivity, vs. up to $982 million if they transfer work to a mixture of substitutes; training-environment changes will cost $204 million. If PAEs decline by 7.2-25.8%, net costs to major teaching hospitals will be zero. If PAEs fall by 3%, the cost to society per death averted would be -$523,000 (95%-confidence interval: -$1.82 million to $685,000) to $2.44 million ($271,000 to $6.91 million). If PAEs rise, the policy will be cost-increasing for teaching hospitals and society.

RESULTS OF SENSITIVITY ANALYSIS:

The total direct annual cost nationwide would be up to $1.34 billion using nurse practitioners/physician assistants, $1.64 billion using attending physicians, $820 million hiring additional residents, vs. 1.42 billion using mixed substitutes.

LIMITATIONS:

The effect on PAEs is unknown. Data were limited for some model parameters.

CONCLUSION:

Implementation decisions greatly affect the cost. Unless PAEs decline substantially, teaching hospitals will lose money. If PAEs decline modestly, the requirements might be cost-saving or cost-effective to society.

PMID:
21779949
PMCID:
PMC3270247
DOI:
10.1007/s11606-011-1775-9
[Indexed for MEDLINE]
Free PMC Article

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