Work Hour Regulation for Physician Trainees: Educational and Clinical Outcomes

实习医师的工作时间规定：教育和临床成果

• 批准号: 7882524
• 负责人: KEVIN G VOLPP
• 金额: $ 77.35万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2012-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7882524
• 关键词: Accreditation; Acute; Affect; American; American College of Physicians; Area; Aviation; Behavioral; Caring; Cessation of life; Charge; Chronic; Clinical; Cognitive; Consensus; Country; Data; Effectiveness; Environment; Face; Failure; Fatigue; Frequencies; Health Services Research; Hearing; Hospitals; Hour; Institute of Medicine (U.S.); Internal Medicine; Knowledge; Length of Stay; Link; Medical; Medical Errors; Medical Examiners; Medicine; Nursing Staff; Occupations; Operative Surgical Procedures; Outcome; Patients; Performance; Physician Assistants; Physicians; Policies; Probability; Quality Indicator; Recommendation; Regulation; Relative (related person); Residencies; Safety; Sampling; Schedule; Site; Sleep Deprivation; Statutes and Laws; Study Section; Surveys; Teaching Hospitals; Time; Training; Training Programs; United States; Work; clinically significant; design; experience; graduate medical education; improved; innovation; medical specialties; mortality; patient safety; planetary Atmosphere; programs; public health relevance; response

DESCRIPTION (provided by applicant): Regulation of work hours for physicians in training was put in place by the Accreditation Council for Graduate Medical Education (ACGME) in 2003, long after similar regulations were implemented in trucking, aviation, and in other occupations where acute and chronic sleep deprivation raise significant concerns about safety. The impact of duty hour regulation has been controversial. While there is some evidence that this improved mortality outcomes in the short-term, little is known about the impact on educational outcomes, longer-term clinical outcomes, or the mechanisms creating inter-hospital differences in the effectiveness of duty hour reform in improving either clinical or educational outcomes. With assistance from the American Board of Surgery, the American Board of Internal Medicine, the National Board of Medical Examiners, the Association of Program Directors in Internal Medicine and Surgery, and the American College of Physicians, we propose to complete the following specific aims: 1. To describe the variety and frequency of program-level behavioral responses to duty hour reform and resident work conditions by conducting national surveys of program directors and residents in Internal Medicine (IM) and General Surgery (GS) informed by qualitative field work at a sample of IM and GS residency programs. 2. To assess how educational outcomes (board scores) have changed over time in conjunction with duty hour reform for residents in different specialties. 3. To examine how clinical outcomes (mortality, failure-to-rescue, probability of a prolonged length of stay, patient safety indicators) have changed over time beyond the first two years post-duty hour reform. 4. To examine the relationship between changes in educational and clinical outcomes and hospital financial performance, physician extender and nurse staffing levels, and program responses identified in the national survey of program directors. The proposed analysis will be the first to pull together national data on educational and clinical outcomes and will help us understand why duty hour regulation reform for physicians in training worked - or did not work - in terms of improving educational and clinical outcomes. This is an important policy question given that the physicians who are the subject of these reforms provide care to tens of millions of Americans each year. PUBLIC HEALTH RELEVANCE Regulation of duty hours for physicians in training in 2003 represented one of the most significant efforts ever undertaken to improve patient safety in American hospitals. It is largely unknown how these regulations affected patient outcomes, the quality of physician training, and how programs responded to improve or maintain patient outcomes and the quality of residency training. In this study, we will examine how residency programs and hospitals responded to the duty hour reform and how these behavioral responses determined which residency programs and hospitals experienced relative improvements or worsening in educational and clinical outcomes, important questions given that tens of millions of Americans receive care from the physicians in training who were the subject of the duty hour regulation.

描述（由申请人提供）：2003年，研究生医学教育认证理事会（ACGME）制定了医生培训工作时间的规定，这是在卡车运输、航空和其他职业实施类似规定很久之后，在这些职业中，急性和慢性睡眠剥夺引起了对安全的严重关注。值班时间规定的影响一直存在争议。虽然有一些证据表明，这在短期内改善了死亡率的结果，很少有人知道的教育成果的影响，长期的临床结果，或机制创建医院间的差异，在改善临床或教育成果的有效性的值班时间改革。在美国外科委员会、美国内科委员会、国家医学检查委员会、内科和外科项目主任协会以及美国医师学院的帮助下，我们建议完成以下具体目标：1.通过对内科（IM）和普通外科（GS）的项目主管和住院医师进行全国性调查，描述项目层面对值班时间改革和住院医师工作条件的行为反应的多样性和频率，调查内容是IM和GS住院医师项目样本的定性实地工作。2.评估教育成果（委员会分数）如何随着时间的推移与不同专业的居民的值班时间改革一起变化。3.研究值班时间后改革的头两年之后，临床结局（死亡率、抢救失败、住院时间延长的概率、患者安全指标）如何随时间变化。4.研究教育和临床结果的变化与医院财务绩效，医生扩展和护士人员配备水平，以及在全国项目负责人调查中确定的项目响应之间的关系。拟议中的分析将是第一个汇集全国教育和临床结果数据的分析，并将帮助我们理解为什么对培训中的医生进行的值班时间规定改革在改善教育和临床结果方面起作用--或不起作用。这是一个重要的政策问题，因为作为这些改革对象的医生每年为数千万美国人提供护理。公共卫生相关性2003年对医生培训值班时间的规定是美国医院为改善病人安全所做的最重要的努力之一。目前还不清楚这些法规如何影响患者的治疗效果，医生培训的质量，以及项目如何改善或维持患者的治疗效果和住院医师培训的质量。在这项研究中，我们将研究住院医师计划和医院如何应对值班时间改革，以及这些行为反应如何决定哪些住院医师计划和医院经历了相对改善或恶化的教育和临床结果，重要的问题是，数千万美国人接受护理的医生在培训谁是值班时间规定的主题。