@article{01ea3ea7e55e4faeb38c95a31e3139c8,
title = "Absence of july phenomenon in acute ischemic stroke care quality and outcomes",
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.",
keywords = "Ischemic stroke, Thrombolysis",
author = "Marco Gonzalez-Castellon and Christine Ju and Ying Xian and Adrian Hernandez and Fonarow, {Gregg C.} and Lee Schwamm and Smith, {Eric E.} and Bhatt, {Deepak L.} and Matthew Reeves and Willey, {Joshua Z.}",
note = "Funding Information: The Get With The Guidelines–Stroke (GWTG-Stroke) program is provided by the American Heart Association/American Stroke Association. The GWTG-Stroke Program is currently supported in part by a charitable contribution from Janssen Pharmaceutical Companies of Johnson & Johnson. GWTG-Stroke has been funded in the past through support from Boeringher-Ingelheim, Merck, Bristol-Myers Squib/Sanofi Pharmaceutical Partnership, and the AHA Pharmaceutical Roundtable. The commercial funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the article; and decision to submit the article for publication. Funding Information: St. Jude Medical, The Medicines Company; Trustee: American College of Cardiology; Unfunded Research: FlowCo, PLx Pharma, Takeda. Dr Fonarow reports being a member of the GWTG Steering Committee and funding from PCORI. Dr Smith reports being a member of the GWTG Steering Committee. Dr Gonzalez-Castellon discloses speaking honoraria from Sanofi and Novartis. Dr Willey discloses NIH funding, K23 NS 073104. Dr Hernandez discloses research support form Amgen, AstraZeneca, Bayer, Genentech, Merck, Novartis, Portola Pharmaceuticals, and consulting from Amgen, AstraZeneca, Merck, and Novartis. Dr Schwamm serves as a volunteer for the American Heart Association as chair of the stroke clinical workgroup for Get with the Guideline-Stroke and chair of the Healthcare Accreditation Science Committee. He serves as the PI of an NINDS-funded SPOTRIAS network trial, MR WITNESS, which is a Phase 2 safety study of alteplase delivered in an extended time window with MR-guided patient selection (NCT01282242). The study is funded primarily by NINDS, and alteplase is provided by Genentech to MGH for distribution to sites, as well as modest per patient supplemental site payments. Genentech has no control over study design, analysis, or publication. He reports receiving significant research support from the Patient-Centered Outcomes Research Institute (PCORI); serving as a stroke systems consultant to the Massachusetts Department of Public Health; and serving as a scientific consultant regarding trial design and conduct to Lundbeck (international steering committee, DIAS3, 4 trial); and Penumbra (data and safety monitoring committee, Separator 3D trial). The remaining authors have no disclosures to report. Publisher Copyright: {\textcopyright} 2018 The Authors.",
year = "2018",
month = feb,
day = "1",
doi = "10.1161/JAHA.117.007685",
language = "English (US)",
volume = "7",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "3",
}