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Absence of July Phenomenon in Acute Ischemic Stroke Care Quality and Outcomes.

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Date
2018-01-31
Authors
Gonzalez-Castellon, Marco
Ju, Christine
Xian, Ying
Hernandez, Adrian
Fonarow, Gregg C
Schwamm, Lee
Smith, Eric E
Bhatt, Deepak L
Reeves, Matthew
Willey, Joshua Z
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Abstract
BACKGROUND:Lower care quality and an increase in adverse outcomes as a result of new medical trainees is a concept well rooted in popular belief, termed the "July phenomenon." Whether this phenomenon occurs in acute ischemic stroke has not been well studied. METHODS AND RESULTS:We analyzed data from patients admitted with ischemic stroke in 1625 hospitals participating in the Get With The Guidelines-Stroke program for the 5-year period between January 2009 and December 2013. We compared acute stroke treatment processes and in-hospitals outcomes among the 4 quarters (first quarter: July-September, last quarter: April-June) of the academic year. Multivariable logistic regression models were used to evaluate the relationship between academic year transition and processes measures. A total of 967 891 patients were included in the study. There was a statistically significant, but modest (<4 minutes or 5 percentage points) difference in distribution of or quality and clinical metrics including door-to-computerized tomography time, door-to-needle time, the proportion of patients with symptomatic intracranial hemorrhage within 36 hours of admission, and the proportion of patients who received defect-free care in stroke performance measures among academic year quarters (P<0.0001). In multivariable analyses, there was no evidence that quarter 1 of the academic year was associated with lower quality of care or worse in-hospital outcomes in teaching and nonteaching hospitals. CONCLUSIONS:We found no evidence of the "July phenomenon" in patients with acute ischemic stroke among hospitals participating in the Get With The Guidelines-Stroke program.
Type
Journal article
Subject
Humans
Brain Ischemia
Treatment Outcome
Patient Admission
Patient Discharge
Registries
Health Status
Time Factors
Internship and Residency
Clinical Competence
Aged
Aged, 80 and over
Middle Aged
Hospitals, Teaching
Personnel Staffing and Scheduling
Quality Indicators, Health Care
United States
Female
Male
Stroke
Time-to-Treatment
Outcome and Process Assessment, Health Care
Permalink
https://hdl.handle.net/10161/21907
Published Version (Please cite this version)
10.1161/jaha.117.007685
Publication Info
Gonzalez-Castellon, Marco; Ju, Christine; Xian, Ying; Hernandez, Adrian; Fonarow, Gregg C; Schwamm, Lee; ... Willey, Joshua Z (2018). Absence of July Phenomenon in Acute Ischemic Stroke Care Quality and Outcomes. Journal of the American Heart Association, 7(3). 10.1161/jaha.117.007685. Retrieved from https://hdl.handle.net/10161/21907.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Hernandez

Adrian Felipe Hernandez

Duke Health Cardiology Professor

Ying Xian

Adjunct Associate Professor in the Department of Neurology
Alphabetical list of authors with Scholars@Duke profiles.
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