دورية أكاديمية
أعرض في EDS

Reassessing the July Effect: 30 Years of Evidence Show No Difference in Outcomes.

التفاصيل البيبلوغرافية
العنوان: Reassessing the July Effect: 30 Years of Evidence Show No Difference in Outcomes.
المؤلفون: Zogg CK; Yale School of Medicine, New Haven, CT.; Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, Boston, MA.; Yale School of Public Health, New Haven, CT., Metcalfe D; Nuffield Department of Orthopedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; and., Sokas CM; Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, Boston, MA., Dalton MK; Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, Boston, MA., Hirji SA; Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, Boston, MA., Davis KA; Yale School of Medicine, New Haven, CT., Haider AH; The Aga Khan University Medical College, Karachi, Pakistan., Cooper Z; Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, Boston, MA., Lichtman JH; Yale School of Public Health, New Haven, CT.
المصدر: Annals of surgery [Ann Surg] 2023 Jan 01; Vol. 277 (1), pp. e204-e211. Date of Electronic Publication: 2021 Feb 25.
نوع المنشور: Systematic Review; Meta-Analysis; Journal Article
اللغة: English
بيانات الدورية: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0372354 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1528-1140 (Electronic) Linking ISSN: 00034932 NLM ISO Abbreviation: Ann Surg Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Philadelphia, PA : Lippincott Williams & Wilkins
مواضيع طبية MeSH: Ischemic Stroke* , Myocardial Infarction*, Humans ; Hospitalization ; Patient Readmission ; Coronary Artery Bypass ; Risk Factors ; Retrospective Studies
مستخلص: Objective: The aim of this study was to critically evaluate whether admission at the beginning versus end of the academic year is associated with increased risk of major adverse outcomes.
Summary Background Data: The hypothesis that the arrival of new residents and fellows is associated with increases in adverse patient outcomes has been the subject of numerous research studies since 1989. Methods: We conducted a systematic review and random-effects meta-analysis of July Effect studies published before December 20, 2019, looking for differences in mortality, major morbidity, and readmission. Given a paucity of studies reporting readmission, we further analyzed 7 years of data from the Nationwide Readmissions Database to assess for differences in 30-day readmission for US patients admitted to urban teaching versus nonteach-ing hospitals with 3 common medical (acute myocardial infarction, acute ischemic stroke, and pneumonia) and 4 surgical (elective coronary artery bypass graft surgery, elective colectomy, craniotomy, and hip fracture) conditions using risk-adjusted logistic difference-in-difference regression.
Results: A total of 113 studies met inclusion criteria; 92 (81.4%) reported no evidence of a July Effect. Among the remaining studies, results were mixed and commonly pointed toward system-level discrepancies in efficiency. Metaanalyses of mortality [odds ratio (95% confidence interval): 1.01 (0.98-1.05)] and major morbidity [1.01 (0.99-1.04)] demonstrated no evidence of a July Effect, no differences between specialties or countries, and no change in the effect over time. A total of 5.98 million patient encounters were assessed for readmission. No evidence of a July Effect on readmission was found for any of the 7 conditions.
Conclusion: The preponderance of negative results over the past 30 years suggests that it might be time to reconsider the need for similarly-themed studies and instead focus on system-level factors to improve hospital efficiency and optimize patient outcomes.
Competing Interests: The authors report no conflicts of interest.
(Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
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معلومات مُعتمدة: F30 AG066371 United States AG NIA NIH HHS; T32 GM007205 United States GM NIGMS NIH HHS; T32 GM136651 United States GM NIGMS NIH HHS; UL1 TR001863 United States TR NCATS NIH HHS
تواريخ الأحداث: Date Created: 20210429 Date Completed: 20230228 Latest Revision: 20240712
رمز التحديث: 20240712
مُعرف محوري في PubMed: PMC8384940
DOI: 10.1097/SLA.0000000000004805
PMID: 33914485
قاعدة البيانات: MEDLINE
الوصف
تدمد:1528-1140
DOI:10.1097/SLA.0000000000004805