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Residency work-hours reform. A cost analysis including preventable adverse events
Teryl K Nuckols1, José J Escarce
1Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, Calif, USA. tnuckols@mednet.ucla.edu
Journal of General Internal Medicine
|September 30, 2005
Summary
Reducing resident work-hours may be cost-neutral for society with a modest 5.1% to 8.5% decrease in preventable adverse events. However, teaching hospitals require a larger 18.5% to 30.9% reduction to achieve cost neutrality.
Area of Science:
- Health economics
- Medical education reform
- Patient safety
Background:
- Federal legislation prompted the Accreditation Council for Graduate Medical Education to limit resident work-hours in July 2003.
- While substantial costs are associated with this reform, successful implementation could lower preventable adverse event costs.
Purpose of the Study:
- To estimate the net cost of resident work-hour reform in 2001 dollars.
- To determine the necessary reduction in preventable adverse events for reform to be cost-neutral from both teaching hospital and societal perspectives.
Main Methods:
- A cost analysis was conducted using published literature and existing data.
- Net costs were calculated for four distinct reform strategies.
- The analysis considered a range of potential impacts on preventable adverse events.
Main Results:
- Transferring excess work to task-tailored substitutes nationwide would cost $673 million; using mid-level providers would cost $1.1 billion.
- Reform strategies that increase adverse events would raise net costs and mortality for teaching hospitals and society.
- Cost neutrality for society is achievable if task-tailored substitutes reduce events by 5.1% or mid-level providers by 8.5%.
Conclusions:
- Most costs associated with preventable adverse events occur post-discharge.
- A modest reduction in adverse events (5.1%–8.5%) could make residency work-hours reform cost-neutral for society.
- Achieving cost neutrality for teaching hospitals requires a significantly larger reduction (18.5%–30.9%) in adverse events, necessitating additional funding or further research into cost-effective reform approaches.