The Impact of Resident Duty Hour Reform on Hospital Readmission Rates Among Medicare Beneficiaries

The Accreditation Council for Graduate Medical Education (ACGME) instituted resident duty hour reform in 2003 aiming to improve outcomes of care. A study to determine the impact of the reform on readmission rates found no resulting change in hospital readmission rates of Medicare patients.

The authors compared readmission rates in more versus less teaching-intensive hospitals, analyzing hospital discharge data from 2000 to 2005 for the odds of readmission of Medicare patients before and after the reform. They also examined secondary outcomes combining measures of readmission and patient mortality. Patients were divided into a combined medical group and a combined surgical group.

Unadjusted readmission rates were highest in major teaching hospitals for both the combined medical and surgical groups. However, risk-adjusted analyses found no change in readmission rates or in secondary outcomes in any level of intensity of teaching hospitals for the combined medical or combined surgical groups.

The reforms did not systematically affect patient outcomes. The authors hypothesize that physician familiarity with patients does not influence the likelihood of readmission, that the benefits of reducing residents’ fatigue counterbalance the negative affects of reduced hours or that other factors more strongly influence readmission. The authors recommend continued monitoring of future reforms to prevent disruptions in the quality of care.