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

dc.contributor.author

Gonzalez-Castellon, Marco

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Ju, Christine

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Xian, Ying

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Hernandez, Adrian

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Fonarow, Gregg C

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Schwamm, Lee

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Smith, Eric E

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Bhatt, Deepak L

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Reeves, Matthew

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Willey, Joshua Z

dc.date.accessioned

2020-12-15T17:18:51Z

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2020-12-15T17:18:51Z

dc.date.issued

2018-01-31

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2020-12-15T17:18:50Z

dc.description.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.

dc.identifier

JAHA.117.007685

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2047-9980

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2047-9980

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https://hdl.handle.net/10161/21907

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eng

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Ovid Technologies (Wolters Kluwer Health)

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Journal of the American Heart Association

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10.1161/jaha.117.007685

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Humans

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Brain Ischemia

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Treatment Outcome

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Patient Admission

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Patient Discharge

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Registries

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Health Status

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Time Factors

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Internship and Residency

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Clinical Competence

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Aged

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Aged, 80 and over

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Middle Aged

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Hospitals, Teaching

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Personnel Staffing and Scheduling

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Quality Indicators, Health Care

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United States

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Female

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Male

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Stroke

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Time-to-Treatment

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Outcome and Process Assessment, Health Care

dc.title

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

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Journal article

duke.contributor.orcid

Xian, Ying|0000-0002-1237-1162

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Hernandez, Adrian|0000-0003-3387-9616

pubs.issue

3

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School of Medicine

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Duke Clinical Research Institute

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Neurology, Neurocritical Care

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Medicine, Clinical Pharmacology

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Duke

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Institutes and Centers

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Neurology

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Clinical Science Departments

pubs.organisational-group

Medicine

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Medicine, Cardiology

pubs.publication-status

Published

pubs.volume

7

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