In Reply: Our studies estimated the total effect of the duty hour reform on mortality in the Medicare and VA populations. Among Medicare patients, we found little evidence that mortality changed in association with the implementation of duty hour reform. Each of the letters observes that the work hour limitation for the residents themselves was only one aspect of the changes set in motion by the duty hour reform, and that changes in care or supervision provided by others may have been involved. This is certainly true,
but it does not alter the basic conclusion that the combination of all the changes prompted by the reform did not alter mortality rates among Medicare patients. The situation is slightly more complex in the VA system, as indicated in the article.
Volpp KG, Rosen A, Rosenbaum P, Romano P, Bellini L, Silber JH. Resident Duty Hour Reform and Mortality in Hospitalized Patients—Reply. JAMA. 2007;298(24):2865–2867. doi:10.1001/jama.298.24.2866-a
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