Absence of July Phenomenon in Acute Ischemic Stroke Care Quality and Outcomes
BackgroundLower 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 ResultsWe analyzed data from p...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-02-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.117.007685 |
| _version_ | 1828309943542874112 |
|---|---|
| author | Marco Gonzalez‐Castellon Christine Ju Ying Xian Adrian Hernandez Gregg C. Fonarow Lee Schwamm Eric E. Smith Deepak L. Bhatt Matthew Reeves Joshua Z. Willey |
| author_facet | Marco Gonzalez‐Castellon Christine Ju Ying Xian Adrian Hernandez Gregg C. Fonarow Lee Schwamm Eric E. Smith Deepak L. Bhatt Matthew Reeves Joshua Z. Willey |
| author_sort | Marco Gonzalez‐Castellon |
| collection | DOAJ |
| description | BackgroundLower 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 ResultsWe 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. ConclusionsWe found no evidence of the “July phenomenon” in patients with acute ischemic stroke among hospitals participating in the Get With The Guidelines–Stroke program. |
| first_indexed | 2024-04-13T15:35:54Z |
| format | Article |
| id | doaj.art-d580218a3e9d4b83ba380e4e4886eaaa |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T15:35:54Z |
| publishDate | 2018-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-d580218a3e9d4b83ba380e4e4886eaaa2022-12-22T02:41:16ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-02-017310.1161/JAHA.117.007685Absence of July Phenomenon in Acute Ischemic Stroke Care Quality and OutcomesMarco Gonzalez‐Castellon0Christine Ju1Ying Xian2Adrian Hernandez3Gregg C. Fonarow4Lee Schwamm5Eric E. Smith6Deepak L. Bhatt7Matthew Reeves8Joshua Z. Willey9Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NEDuke Clinical Research Institute, Durham, NCDepartment of Medicine, Duke University School of Medicine, Durham, NCDepartment of Medicine, Duke University School of Medicine, Durham, NCRonald Reagan–UCLA Medical Center, Los Angeles, CADepartment of Neurology, Massachusetts General Hospital, Boston, MAHotchkiss Brain Institute, University of Calgary, Alberta, CanadaBrigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MADepartment of Epidemiology, Michigan State University, East Lansing, MIDivision of Stroke, Department of Neurology, Columbia University Medical Center, New York, NYBackgroundLower 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 ResultsWe 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. ConclusionsWe found no evidence of the “July phenomenon” in patients with acute ischemic stroke among hospitals participating in the Get With The Guidelines–Stroke program.https://www.ahajournals.org/doi/10.1161/JAHA.117.007685ischemic strokethrombolysis |
| spellingShingle | Marco Gonzalez‐Castellon Christine Ju Ying Xian Adrian Hernandez Gregg C. Fonarow Lee Schwamm Eric E. Smith Deepak L. Bhatt Matthew Reeves Joshua Z. Willey Absence of July Phenomenon in Acute Ischemic Stroke Care Quality and Outcomes Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease ischemic stroke thrombolysis |
| title | Absence of July Phenomenon in Acute Ischemic Stroke Care Quality and Outcomes |
| title_full | Absence of July Phenomenon in Acute Ischemic Stroke Care Quality and Outcomes |
| title_fullStr | Absence of July Phenomenon in Acute Ischemic Stroke Care Quality and Outcomes |
| title_full_unstemmed | Absence of July Phenomenon in Acute Ischemic Stroke Care Quality and Outcomes |
| title_short | Absence of July Phenomenon in Acute Ischemic Stroke Care Quality and Outcomes |
| title_sort | absence of july phenomenon in acute ischemic stroke care quality and outcomes |
| topic | ischemic stroke thrombolysis |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.117.007685 |
| work_keys_str_mv | AT marcogonzalezcastellon absenceofjulyphenomenoninacuteischemicstrokecarequalityandoutcomes AT christineju absenceofjulyphenomenoninacuteischemicstrokecarequalityandoutcomes AT yingxian absenceofjulyphenomenoninacuteischemicstrokecarequalityandoutcomes AT adrianhernandez absenceofjulyphenomenoninacuteischemicstrokecarequalityandoutcomes AT greggcfonarow absenceofjulyphenomenoninacuteischemicstrokecarequalityandoutcomes AT leeschwamm absenceofjulyphenomenoninacuteischemicstrokecarequalityandoutcomes AT ericesmith absenceofjulyphenomenoninacuteischemicstrokecarequalityandoutcomes AT deepaklbhatt absenceofjulyphenomenoninacuteischemicstrokecarequalityandoutcomes AT matthewreeves absenceofjulyphenomenoninacuteischemicstrokecarequalityandoutcomes AT joshuazwilley absenceofjulyphenomenoninacuteischemicstrokecarequalityandoutcomes |