Impact of resident work hour rules on errors and quality

驻场工作时间规则对错误和质量的影响

• 批准号: 7067222
• 负责人: KEVIN G VOLPP
• 金额: $ 50.6万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-05-20 至 2008-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7067222
• 关键词: Medicare /Medicaid; behavioral /social science research tag; bioperiodicity; clinical research; health care personnel performance; health care policy; health care quality; health services research tag; hospital analysis; hospital length of stay; hospital patient care; human data; human mortality; longitudinal human study; medical complication; meta analysis; outcomes research; patient safety /medical error; physicians; sleep deprivation; statistics /biometry

DESCRIPTION (provided by the applicant): The Accreditation Council for Graduate Medical Education (ACGME) released rules effective July 1, 2003 that affected duty hours for all ACGME-accredited residency programs in all specialties. These rules represent the largest national effort to reduce medical errors since the publication of the Institute of Medicine's To Err is Human in 2000 and will directly impact the health care received by the 44% of patients cared for in teaching hospitals in the United States. By reducing sleep deprivation, the rules will likely have beneficial effects on patient safety and quality of care, but worsened continuity of care may counterbalance some of these benefits. This project will evaluate the effect of the duty hour rules on patient safety and quality of care, utilizing national data available though Medicare and pre-validated measures of quality including the AHRQ Quality Indicators. The primary aims of the project are to compare changes in the rate of mortality and failure-to-rescue (death after complications) in teaching hospitals and non-teaching hospitals before and after implementation of the ACGME work hour rules. Diagnoses studied will include all patients admitted for general, orthopedic, or vascular surgery and medical diagnoses of acute myocardial infarction, gastrointestinal bleeding, or stroke. The secondary aims are to examine differences in AHRQ Patient Safety Indicators (PSIs) before and after the rule change and to study how length of stay (LOS), the probability of a prolonged length of stay, and conditional length of stay (LOS once a stay is prolonged) changed in teaching vs. non-teaching hospitals. The study will be based on approximately 16 million surgical and medical admissions collected from the Medicare's MEDPAR data set spanning the years 1999-2003 (before the rule change) and 2003-2005 (after the rule change). We will use a multiple time series design with non-teaching hospitals as a control for teaching hospitals and will examine how effects differ in accordance with hospital dependence on residents (resident/bed ratio), program type and size, and hospitals' baseline financial status. The study will be powered to detect very small differences in these outcomes and will be able to test definitively whether the duty hour reform improved (or possibly worsened) patient safety and quality of care. Results from this study will be central to any future efforts to reduce errors in teaching hospitals through resident work hour reform.

描述（由申请人提供）：研究生医学教育认证委员会 (ACGME) 发布了 2003 年 7 月 1 日生效的规则，影响了所有经 ACGME 认证的所有专业住院医师项目的值班时间。这些规则代表了自 2000 年医学研究所出版《犯错是人》以来为减少医疗差错而做出的最大规模的全国性努力，并将直接影响美国教学医院 44% 的患者接受的医疗保健。通过减少睡眠剥夺，这些规则可能会对患者安全和护理质量产生有益影响，但护理连续性的恶化可能会抵消其中一些好处。该项目将利用通过 Medicare 提供的国家数据以及包括 AHRQ 质量指标在内的预先验证的质量措施，评估值班时间规则对患者安全和护理质量的影响。该项目的主要目的是比较ACGME工作时间规则实施前后教学医院和非教学医院的死亡率和抢救失败率（并发症后死亡）的变化。研究的诊断将包括所有入院接受普通、骨科或血管手术的患者以及急性心肌梗死、胃肠道出血或中风的医学诊断的患者。第二个目标是检查规则变更前后 AHRQ 患者安全指标 (PSI) 的差异，并研究教学医院与非教学医院的住院时间 (LOS)、延长住院时间的概率和有条件住院时间（一旦延长住院时间后的 LOS）如何变化。该研究将基于 1999-2003 年（规则变更前）和 2003-2005 年（规则变更后）Medicare 的 MEDPAR 数据集中收集的约 1600 万例手术和医疗入院病例。我们将使用非教学医院的多时间序列设计作为教学医院的对照，并将根据医院对住院医师的依赖（住院医师/床位比率）、项目类型和规模以及医院的基线财务状况来研究效果有何不同。该研究将能够检测这些结果中非常小的差异，并将能够明确测试工作时间改革是否改善（或可能恶化）患者安全和护理质量。这项研究的结果对于未来通过住院医师工作时间改革减少教学医院错误的努力至关重要。