Residual residence reductions do not significantly affect patient quality, including mammalian mortality, according to a study published online today in BMJ .
With data showing similar patient results, the expert said that the focus now needs to be changed from discussing the total number of hours spent by the residents in the hospital on how these hours are spent
In 2003, the Academic Training Accreditation Council (ACGME) initiated a work week requirement for residents do not exceed 80 hours and it does not go beyond 30 hours. The changes came as a result of a publicly published death in a New York teaching hospital and raising concerns about the safety of patients who are fractured by tired residents. Subsequent reforms 201
"The reduction of working hours gave rise to discussions on whether working less hours during the residency would result in doctors entering independent practices that were inadequately prepared," author Anupam B. Jena, MD, of Harvard Medical School's Boston, MD, told MD. Massachusetts, Medscape Medical News via email.
To answer the question, Jena and colleagues compared patient results for doctors trained in internal medicine before and after residence hours for working hours. They found that the reduction of working hours was not linked to disease mortality, readmission and health care costs.
"These results should really inform the debate, but maybe not stop it," Jena said.
"It is important to acknowledge that health care is different than it was 20-30 years ago, in a way that reduces the role of an individual doctor in driving the patient's results. It is possible that the future instructor adequately can be prepared for independent exercise with less than 80 hours a week during a residence permit, "he explained.
When asked for comment, Sanjay Desai, MD, Vice President of Education and Program Director of Internal Medicine at Johns Hopkins University, Baltimore, Maryland, said that the study is important because it evaluated the practitioner after completing the training. Previous studies, however, evaluated doctors during exercise.
For example, the results of the individualized comparative effect of models that optimize patient safety and settlement training (iCOMPARE) showed that with limited hours, there was no change in patient outcomes and no falls in training outcomes for trainees.
However, few studies have evaluated the long-term effects of a reduction in exercise hours. Only another study, conducted in Florida, has done so, and the results cannot be generalized to other states, says Desai, who has served on the ACGME Committee, which sets working hours limits on working hours and whose research is focused on this area.
The study by Jena and colleagues "is a unique contribution because it actually evaluates the clinics' performance after they have completed the training. It confirms to me that the discussion about the number of hours spent in the hospital during exercise is not an important discussion anymore," Desai says. .
Instead of talking about the absolute number of hours worked, the focus should be on how these hours are spent, he explained.
One of the most important variables that must be assessed as a burned out doctor, he emphasized. Other important variables include professionalization, doctors' attitudes, communication skills, development of specific clinical skills and work time effects on health.
"This study, in my opinion, confirms that we must move away from the number of hours to differences in how we spend the hours and how it associates with these other results, including the well-being of doctors. That type of research is desperately necessary for the country,
Nearly 500,000 assumptions are analyzed
For the Jena and colleagues study, 485,685 assays analyzed for patients admitted under Medicare Part B between January 2000 and December 2012.
They compared the results of patients being cared for by doctors who were in their first year of independent practice and who completed housing before 2000-2006) and after (2007-2012) the ACGME reforms with outcomes of patients taken care of by senior interns who were in their 10th year of independence on ractice in the same year. A difference in difference analysis showed no significant difference between the training periods for any of the results examined.
Blan In the first internists, the 30-day mortality rate was 10.6% for those who completed the pre-reform training and 9.6% for those who completed training after reform. Among senior physicians, interest rates were 11.2% and 10.6% for the same periods.
Likewise, 30-day withdrawal rates among patients taken care of by pre-treatment and post-reform of first-year internists were the same, at 20.4%. For leading internists, interest rates were 20.1% and 20.5% during the same year.
The inhalation expenses were also similar. Among the first internists, the expenses were 1161 USD and 1267 USD per hospital intake for them in their respective reforms and after reform groups. Patient spending among seniors was $ 1331 and $ 1599 for the same periods.
The study has several potential limitations, including its observation design and inclusion of internists. The authors warn that the results cannot be generalized to other types of housing, especially surgical residents, for whom exposure to a certain amount of procedures can make a difference.
The use of the 30-day mortality endpoint may also have darkened differences between study groups. But decision makers are probably most interested in this end point and would change rules on working hours if any differences were found, Desai explained.
The study was sponsored by the National Institutes of Health. One or more authors have received consulting fees from one or more of the following: Pfizer, Hill Rom Services, Bristol-Myers Squibb, Novartis, Amgen, Eli Lilly, Vertex Pharmaceuticals, AstraZeneca, Celgene, Tesaro, Sanofi Aventis, Biogen, Precision Health Economics, Analysis Group and precision health economics. A writer is employed by devoted health. Desai has revealed no relevant economic relationships.
BMJ. Posted on July 10, 2019. Fulltext
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