Cost implications of reduced work hours and workloads for resident physicians.

BACKGROUND: Although the Accreditation Council for Graduate Medical Education (ACGME) limits the work hours of residents, concerns about fatigue persist. A new Institute of Medicine (IOM) report recommends, among other changes, improved adherence to the 2003 ACGME limits, naps during extended shifts, a 16-hour limit for shifts without naps, and reduced workloads. METHODS: We used published data to estimate labor costs associated with transferring excess work from residents to substitute providers, and we examined the effects of our assumptions in sensitivity analyses. Next, using a probability model to represent labor costs as well as mortality and costs associated with preventable adverse events, we determined the net costs to major teaching hospitals and cost-effectiveness across a range of hypothetical changes in the rate of preventable adverse events. RESULTS: Annual labor costs from implementing the IOM recommendations were estimated to be $1.6 billion (in 2006 U.S. dollars) across all ACGME-accredited programs ($1.1 billion to $2.5 billion in sensitivity analyses). From a 10% decrease to a 10% increase in preventable adverse events, net costs per admission ranged from $99 to $183 for major teaching hospitals and from $17 to $266 for society. With 2.5% to 11.3% decreases in preventable adverse events, costs to society per averted death ranged from $3.4 million to $0. CONCLUSIONS: Implementing the four IOM recommendations would be costly, and their effectiveness is unknown. If highly effective, they could prevent patient harm at reduced or no cost from the societal perspective. However, net costs to teaching hospitals would remain high.

A role for Community HealthCorps members in youth HIV/AIDS prevention education.

One-half of all new infections with the human immunodeficiency virus (HIV) and cases of acquired immunodeficiency syndrome (AIDS) occur in young people under age 25. While many markers for the spread of HIV/AIDS have been declining, the Centers for Disease Control and Prevention (CDC) reports no similar reduction in newly diagnosed HIV cases among youth. These findings point to the need for greater prevention and education efforts to help curb the spread of HIV/AIDS among the nation's youth. Community HealthCorps members working in community health centers provided HIV/AIDS prevention education to youth as part of their community service work. After HealthCorps members received training in the HIV/AIDS prevention curriculum, Be Proud! Be Responsible!, they recruited young people from their communities to participate in the program. HealthCorps members provided prevention education to students to ensure they acquired basic knowledge about HIV/AIDS on which to base personal decisions and actions. Staff of the Adolescent School Health Initiative of the National Association of Community Health Centers assessed the impact of the education on youth knowledge of HIV/AIDS, understanding of personal risk, their ability to refuse or negotiate safer sex, and proper use of condoms. This article highlights findings and summarizes lessons learned from the prevention education initiative.