H epatic encephalopathy (HE) is a common complication of cirrhosis resulting in relapsing-remitting mental status changes ranging from deficits in executive function to coma. Incident HE is associated with an abrupt increase in mortality 1 and frequent hospitalization. 2 To further the understanding of the burden and impact of HE at the population level, valid algorithms are required to identify patients in administrative data. An International Classification of Diseases (ICD)-9 code is specific for HE (572.2), offering a 0.92 positive predictive value (PPV) and 0.36 negative predictive value (NPV). 3 When applied in an algorithm to patients with ICD-9 codes for cirrhosis (eg, 571.5), Kanwal et al 4 found a PPV and NPV of 0.86 and 0.87. Unfortunately, the switch to ICD-10 in 2015 rendered algorithms validated using ICD-9 invalid. Kaplan et al 5 previously showed that lactulose and rifaximin use correlated with grade of HE for Child classification. Herein, we validate a diagnostic coding algorithm for HE using ICD-10 and medication records.
Purpose
To determine whether the 2003 Accreditation Council for Graduate Medical
Education (ACGME) duty hours reform affected medical knowledge as reflected by written
board scores for internal medicine (IM) residents.
Method
The authors conducted a retrospective cohort analysis of post graduate year-1
(PGY-1) Internal Medicine residents who started training before and after the 2003 duty
hour reform using a merged data set of American Board of Internal Medicine (ABIM) Board
examination and the National Board of Medical Examiners (NMBE) United States Medical
Licensing Examination (USMLE) Step 2 Clinical Knowledge test scores. Specifically, using
four regression models, the authors compared IM residents beginning PGY-1 training in
2000 and completing training unexposed to the 2003 duty hours reform (PGY-1 2000 cohort,
n=5,475) to PGY-1 cohorts starting in 2001 through 2005 (n=28,008), all with some
exposure to the reform.
Results
The mean ABIM board score for the unexposed PGY-1 2000 cohort (n=5,475) was
491, SD = 85. Adjusting for demographics, program, and USMLE Step 2 exam score, the mean
differences (95% CI) in ABIM board scores between the PGY-1 2001, 2002, 2003, 2004 and
2005 cohorts minus the PGY-1 2000 cohort were −5.43 (−7.63, −3.23),
-3.44 (−5.65, −1.24), 2.58 (0.36, 4.79), 11.10 (8.88, 13.33) and 11.28
(8.98, 13.58) points respectively. None of these differences exceeded one-fifth of an SD
in ABIM board scores.
Conclusion
The duty hour reforms of 2003 did not meaningfully affect medical knowledge as
measured by scores on the ABIM board examinations.
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