Absence of July Phenomenon in Acute Ischemic Stroke Care Quality and Outcomes.
dc.contributor.author | Gonzalez-Castellon, Marco | |
dc.contributor.author | Ju, Christine | |
dc.contributor.author | Xian, Ying | |
dc.contributor.author | Hernandez, Adrian | |
dc.contributor.author | Fonarow, Gregg C | |
dc.contributor.author | Schwamm, Lee | |
dc.contributor.author | Smith, Eric E | |
dc.contributor.author | Bhatt, Deepak L | |
dc.contributor.author | Reeves, Matthew | |
dc.contributor.author | Willey, Joshua Z | |
dc.date.accessioned | 2020-12-15T17:18:51Z | |
dc.date.available | 2020-12-15T17:18:51Z | |
dc.date.issued | 2018-01-31 | |
dc.date.updated | 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 | |
dc.identifier.issn | 2047-9980 | |
dc.identifier.issn | 2047-9980 | |
dc.identifier.uri | ||
dc.language | eng | |
dc.publisher | Ovid Technologies (Wolters Kluwer Health) | |
dc.relation.ispartof | Journal of the American Heart Association | |
dc.relation.isversionof | 10.1161/jaha.117.007685 | |
dc.subject | Humans | |
dc.subject | Brain Ischemia | |
dc.subject | Treatment Outcome | |
dc.subject | Patient Admission | |
dc.subject | Patient Discharge | |
dc.subject | Registries | |
dc.subject | Health Status | |
dc.subject | Time Factors | |
dc.subject | Internship and Residency | |
dc.subject | Clinical Competence | |
dc.subject | Aged | |
dc.subject | Aged, 80 and over | |
dc.subject | Middle Aged | |
dc.subject | Hospitals, Teaching | |
dc.subject | Personnel Staffing and Scheduling | |
dc.subject | Quality Indicators, Health Care | |
dc.subject | United States | |
dc.subject | Female | |
dc.subject | Male | |
dc.subject | Stroke | |
dc.subject | Time-to-Treatment | |
dc.subject | Outcome and Process Assessment, Health Care | |
dc.title | Absence of July Phenomenon in Acute Ischemic Stroke Care Quality and Outcomes. | |
dc.type | Journal article | |
duke.contributor.orcid | Xian, Ying|0000-0002-1237-1162 | |
duke.contributor.orcid | Hernandez, Adrian|0000-0003-3387-9616 | |
pubs.issue | 3 | |
pubs.organisational-group | School of Medicine | |
pubs.organisational-group | Duke Clinical Research Institute | |
pubs.organisational-group | Neurology, Neurocritical Care | |
pubs.organisational-group | Medicine, Clinical Pharmacology | |
pubs.organisational-group | Duke | |
pubs.organisational-group | Institutes and Centers | |
pubs.organisational-group | Neurology | |
pubs.organisational-group | Clinical Science Departments | |
pubs.organisational-group | Medicine | |
pubs.organisational-group | Medicine, Cardiology | |
pubs.publication-status | Published | |
pubs.volume | 7 |
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