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）：认证研究生医学教育委员会（ACGME）对医师进行培训的工作时间进行了调节，此后很长一段时间以来在卡车运输，航空和其他职业中实施了类似的法规，在这些法规中，急性和慢性睡眠剥夺引起了对安全的重大关注。占空公司监管的影响一直存在争议。尽管有一些证据表明这种改善的死亡率在短期内提高了死亡率，但对对教育结果，长期临床结果的影响或在改善临床或教育结果方面的有效性改革的有效性上造成了院内差异的机制知之甚少。在美国外科委员会，美国内科委员会，全国体检医师委员会，内科和外科手术计划主管协会以及美国医师学院的协助下，我们建议完成以下具体目的：1。描述计划级别的行为态度的多样性和频率。在IM和GS居住计划样本中进行定性现场工作。 2。评估教育成果（董事会成绩）如何随着时间的流逝而与不同专业的居民的占空公司改革结合使用。 3。检查临床结果（死亡率，失败，延长逗留时间的可能性，患者安全指标的概率）如何随着时间的推移而变化，超过了后两年后的改革。 4。检查教育和临床成果的变化与医院财务绩效，医师的扩展和护士人员配备水平以及计划董事调查中确定的计划响应之间的关系。拟议的分析将是第一个将有关教育和临床结果的国家数据汇总在一起，并将帮助我们理解为什么在培训中为医生在改善教育和临床结果方面对医生的税务时间调节改革。这是一个重要的政策问题，鉴于这些改革的主题的医生每年为数千万美国人提供护理。公共卫生相关性监管于2003年在培训中为医生的工作时间的关税时间是为了改善美国医院的患者安全而采取的最重要的努力之一。这些法规在很大程度上未知如何影响患者的结果，医师培训的质量以及如何响应改善或维持患者结果以及居住培训质量的计划。在这项研究中，我们将研究居住计划和医院如何应对值班时间改革的反应，以及这些行为反应如何确定哪些居住计划和医院在教育和临床成果方面经历了相对改善或恶化，鉴于数以千计的美国人在培训中受到培训的医生的照料，这些问题是培训的医生，这些问题是关税时间监管的主题。