存在“七月现象”吗？七月入院对教学医院重症监护死亡率和住院时间的影响。
Is there a July phenomenon? The effect of July admission on intensive care mortality and length of stay in teaching hospitals.
作者信息
Barry William A, Rosenthal Gary E
机构信息
Division of General Internal Medicine, Department of Medicine, Iowa City VA Medical Center, Iowa City, Iowa, USA.
出版信息
J Gen Intern Med. 2003 Aug;18(8):639-45. doi: 10.1046/j.1525-1497.2003.20605.x.
BACKGROUND
It has been suggested that inexperience of new housestaff early in an academic year may worsen patient outcomes. Yet, few studies have evaluated the "July Phenomenon," and no studies have investigated its effect in intensive care patients, a group that may be particularly susceptible to deficiencies in management stemming from housestaff inexperience.
OBJECTIVE
Compare hospital mortality and length of stay (LOS) in intensive care unit (ICU) admissions from July to September to admissions during other months, and compare that relationship in teaching and nonteaching hospitals, and in surgical and nonsurgical patients.
DESIGN, SETTING, AND PATIENTS: Retrospective cohort analysis of 156,136 consecutive eligible patients admitted to 38 ICUs in 28 hospitals in Northeast Ohio from 1991 to 1997.
RESULTS
Adjusting for admission severity of illness using the APACHE III methodology, the odds of death was similar for admissions from July through September, relative to the mean for all months, in major (odds ratio [OR], 0.96; 95% confidence interval [95% CI], 0.91 to 1.02; P =.18), minor (OR, 1.02; 95% CI, 0.93 to 1.10; P =.66), and nonteaching hospitals (OR, 0.96; 95% CI, 0.91 to 1.01; P =.09). The adjusted difference in ICU LOS was similar for admissions from July through September in major (0.3%; 95% CI, -0.7% to 1.2%; P =.61) and minor (0.2%; 95% CI, -0.9% to 1.4%; P =.69) teaching hospitals, but was somewhat shorter in nonteaching hospitals (-0.8%; 95% CI, -1.4% to -0.1%; P =.03). Results were similar when individual months and academic years were examined separately, and in stratified analyses of surgical and nonsurgical patients.
CONCLUSIONS
We found no evidence to support the existence of a July phenomenon in ICU patients. Future studies should examine organizational factors that allow hospitals and residency programs to compensate for inexperience of new housestaff early in the academic year.
背景
有人提出，新住院医师在学年伊始缺乏经验可能会使患者的治疗结果恶化。然而，很少有研究评估“七月现象”，且尚无研究调查其对重症监护患者的影响，这一群体可能特别容易受到住院医师经验不足所导致的管理缺陷的影响。
目的
比较7月至9月入住重症监护病房（ICU）的患者与其他月份入住患者的医院死亡率和住院时间（LOS），并比较教学医院和非教学医院以及外科和非外科患者中的这种关系。
设计、设置和患者：对1991年至1997年期间俄亥俄州东北部28家医院的38个ICU收治的156,136例连续符合条件的患者进行回顾性队列分析。
结果
使用急性生理与慢性健康状况评分系统Ⅲ（APACHE III）方法对入院时的疾病严重程度进行调整后，相对于所有月份的平均值，7月至9月入院患者的死亡几率在大型（优势比[OR]，0.96；95%置信区间[95%CI]，0.91至1.02；P = 0.18）、小型（OR，1.02；95%CI，0.93至1.10；P = 0.66）和非教学医院（OR，0.96；95%CI，0.91至1.01；P = 0.09）中相似。7月至9月入院患者在大型（0.3%；95%CI，-0.7%至1.2%；P = 0.61）和小型（0.2%；95%CI，-0.9%至1.
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