Abstract
OBJECTIVE: To conduct a statewide analysis of the effect of New York’s regulations, limiting internal medicine and family practice residents’ work hours, on patient mortality.
DESIGN: Retrospective study of inpatient discharge files for 1988 (before the regulations) and 1991 (after the regulations).
SETTING AND PATIENTS: Adult patients discharged from New York teaching hospitals (170,214) and nonteaching hospitals (143,455) with a principal diagnosis of congestive heart failure, acute myocardial infarction, or pneumonia, for the years 1988 and 1991 (periods before and after Code 405 regulations went into law). Patients from nonteaching hospitals served as controls.
MEASUREMENT: In-hospital mortality.
RESULTS: Combined unadjusted mortality for congestive heart failure, acute myocardial infarction, and pneumonia patients declined between 1988 and 1991 in both teaching (14.1% to 13.0%; P=.0001) and nonteaching hospitals (14.0% to 12.5%; P=.0001). Adjusted mortality also declined between 1988 and 1991 in both teaching (odds ratio [OR], death 1991/1988, 0.868; 95% confidence interval [CI], 0.843 to 0.894; P=.0001) and nonteaching hospitals (OR, death 1991/1988, 0.853; 95% CI, 0.826 to 0.881; P=.0001). This beneficial trend toward lower mortality over time was nearly identical between teaching and nonteaching hospitals (P=.4348).
CONCLUSION: New York’s mandated limitations on residents’ work hours do not appear to have positively or negatively affected in-hospital mortality from congestive heart failure, acute myocardial infarction, or pneumonia in teaching hospitals.
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References
Supreme Court of the State of New York, County of New York. Part 50. Report of the Fourth Grand Jury for the April/May Term of 1986 Concerning the Care and Treatment of a Patient and the Supervision of Interns and Junior Residents at a Hospital in New York County. New York: Supreme Court of the State of New York; 1986:50.
State of New York, Department of Health Memorandum. Health Facilities Series H-40. Subject: Revised Part 405 Hospitals—Minimum Standards: Series 88–66, August 22, 1988:6–8.
Conigliaro J, Frishman WH, Lazar EJ, Croen L. Internal medicine residents and attending physician perceptions of the impact of the New York State Section 405 regulations on working conditions and supervision of residents in two training programs. J Gen Intern Med. 1993;8:502–7.
Kelly A, Marks F, Westhoff C, Rosen M. The effect of the New York State restrictions on resident work hours. Obstet Gynecol. 1991;78:468–73.
American Medical Association. Annual 2001 Reports. Report F (A-01 RFS). Chicago, Ill: American Medical Association.
Petition Requesting a Limit on Medical Resident Work Hours, Washington, DC. Public Citizen. April 30, 2001.
Ayanian JZ, Weissman JS, Chasan-Taber S, Epstein AM. Quality of care for two common illnesses in teaching and non-teaching hospitals. Health Aff (Millwood). 1998;17:194–205.
Chen J, Radford MJ, Wang Y, Marciniak TA, Krumholz HM. Do “America’s Best Hospitals” perform better for acute myocardial infarction? N Engl J Med. 1999;340:286–92.
Capewell S, Kendrick S, Boyd J, Cohen G, Juszczak E, Clarke J. Measuring outcomes: one month survival after acute myocardial infarction in Scotland. Heart. 1996;76:70–5.
Costantini O, Huck K, Carlson MD, et al. Impact of a guideline-based disease management team on outcomes of hospitalized patients with congestive heart failure. Arch Intern Med. 2001;161:177–82.
Philbin EF, Rocco TA, Lindenmuth NW, Ulrich K, McCall M, Jenkins PL. The results of a randomized trial of a quality improvement intervention in the care of patients with heart failure. The MISCHF Study Investigators. Am J Med. 2000;109:443–9.
Meehan TP, Chua-Reyes JM, Tate J, et al. Process of care performance, patient characteristics, and outcomes in elderly patients hospitalized with community-acquired or nursing home-acquired pneumonia. Chest. 2000;117:1378–85.
Fine MJ, Stone RA, Singer DE, et al. Processes and outcomes of care for patients with community-acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team (PORT) cohort study. Arch Intern Med. 1999;159:970–80.
Iezzoni LI, Burnside S, Sickles L, Moskowitz M, Sawitz E, Levine P. Coding of acute myocardial infarction. Clinical and policy implications. Ann Intern Med. 1988;109:745–51.
Udvarhelyi I, Gatsonis C, Epstein A, Pashos C, Newhouse J, McNeil B. Acute myocardial infarction in the Medicare population. Process of care and clinical outcomes. JAMA. 1992;268:2530–6.
Medical-Index ICD-9-CM. International Classification of Diseases, 9th Revision, Clinical Modification, 4th edn. Vol. 1 & 2, 1994.
Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36:8–27.
Elashoff JD. nQuery Advisor, Version 4.0. Saugus, Mass: Statistical Solutions; 1995.
Laine C, Goldman L, Soukup JR, Hayes JG. The impact of a regulation restricting medical house staff working hours on the quality of patient care. JAMA. 1993;269:374–8.
Greene M. For Whom the ‘Bell’ Tolls: How Hospitals Violate the ‘Bell’ Regulations Governing Resident Working Conditions. New York: Public Advocate’s Office for the City of New York; 1994.
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Howard, D.L., Silber, J.H. & Jobes, D.R. Do regulations limiting residents’ work hours affect patient mortality?. J GEN INTERN MED 19, 1–7 (2004). https://doi.org/10.1111/j.1525-1497.2004.30336.x
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DOI: https://doi.org/10.1111/j.1525-1497.2004.30336.x