Association of the 2017 ACGME US Resident Duty Hour Policy Change With Hospital Quality and Patient Experience

Abstract

Background: In 2017, the Accreditation Council for Graduate Medical Education (ACGME) updated select US residency duty hour requirements to improve continuity of care and resident education. It is unknown if this policy change affected hospital quality of care and patient experience. Objective: To evaluate the association of the 2017 duty hour policy change with hospital quality and patient experience in teaching vs nonteaching hospitals. Methods: In this observational difference-in-differences (DiD) study, hospital quality (patient outcomes) and patient experience metrics were obtained from Centers for Medicare & Medicaid Services Care Compare data from before (July 1, 2014-June 30, 2016) and after (July 1, 2017-June 30, 2019) the 2017 policy change in teaching and nonteaching hospitals. Primary outcomes include hospital quality (five 30-day readmission indicator rates, five 30-day mortality rates, 8 patient safety indicators), and patient experience (5 measures from Hospital Consumer Assessment of Healthcare Providers and Systems survey). Results: A total of 2935 hospitals (250 teaching; 2685 nonteaching) were included. When comparing before and after the 2017 policy change, teaching hospitals had greater reductions in hospital-wide readmission (DiD coefficient -0.26; 95% CI, -0.34 to -0.18; P<.001), heart failure readmission (DiD coefficient -0.48; 95% CI, -0.78 to -0.19; P<.002), and stroke mortality rates (DiD coefficient -0.56; 95% CI, -0.94 to -0.19; P<.01) than did nonteaching hospitals. There were no significant differences between teaching and nonteaching hospitals in other outcomes before vs after policy change. Conclusions: After the 2017 duty hour policy change, there was no evidence of worsening of hospital quality or patient experience in teaching hospitals, compared to nonteaching hospitals.