Myers Laura, Mikhael Bassem, Currier Paul, Berg Katherine, Jena Anupam, Donnino Michael, Andersen Lars W
Division of Pulmonary/Critical Care, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States; Division of Pulmonary/Critical Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.
Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.
Resuscitation. 2017 May;114:133-140. doi: 10.1016/j.resuscitation.2017.03.004. Epub 2017 Mar 8.
The July Effect refers to adverse outcomes that occur as a result of turnover of the physician workforce in teaching hospitals during the month of June.
As a surrogate for physician turnover, we used a multivariable difference-in-difference approach to determine if there was a difference in outcomes between May and July in teaching versus non-teaching hospitals.
We used prospectively collected observational data from United States hospitals participating in the Get With The Guidelines-Resuscitation registry. Participants were adults with index in-hospital cardiac arrest between 2005-2014. They were a priori divided by location of arrest (general medical/surgical ward, intensive care unit, emergency department). The primary outcome was survival to hospital discharge. Secondary outcomes included neurological outcome at discharge, return of spontaneous circulation, and several process measures.
We analyzed 16,328 patients in intensive care units, 11,275 in general medical/surgical wards and 3790 in emergency departments. Patient characteristics were similar between May and July in both teaching and non-teaching hospitals. The models for intensive care unit patients indicated the presence of a July Effect with the difference-in-difference ranging between 1.9-3.1%, which reached statistical significance (p<0.05) in all but one model (p=0.07). Visual inspection of monthly survival curves did not show a discernible trend, and no July Effect was observed for return of spontaneous circulation, neurological outcome or process measures except for airway confirmation in the intensive care unit. We found no July Effect for survival in emergency departments or general medical/surgical wards (p>0.20 for all models).
There may be a July Effect in the intensive care unit but the results were mixed. Most survival models showed a statistically significant difference but this was not supported by the secondary analyses of return of spontaneous circulation and neurological outcome. We found no July Effect in the emergency department or the medical/surgical ward for patients with in-hospital cardiac arrest.
“七月效应”指的是教学医院在6月份医生队伍更替所导致的不良后果。
作为医生更替的替代指标，我们采用多变量差分法来确定教学医院与非教学医院在5月和7月的治疗结果是否存在差异。
我们使用了参与“遵循指南 - 复苏”注册研究的美国医院前瞻性收集的观察数据。参与者为2005年至2014年期间在医院发生首次心脏骤停的成年人。他们根据心脏骤停发生地点（普通内科/外科病房、重症监护病房、急诊科）进行了先验分组。主要结局是出院存活。次要结局包括出院时的神经学结局、自主循环恢复以及多项过程指标。
我们分析了16328例重症监护病房患者、11275例普通内科/外科病房患者和3790例急诊科患者。教学医院和非教学医院5月和7月的患者特征相似。重症监护病房患者的模型显示存在“七月效应”，差分范围在1.9%至3.1%之间，除一个模型外（p = 0.07），在所有模型中均达到统计学显著性（p < 0.05）。对月度生存曲线的直观检查未显示出明显趋势，除重症监护病房的气道确认外，未观察到自主循环恢复、神经学结局或过程指标存在“七月效应”。我们发现急诊科或普通内科/外科病房的存活情况不存在“七月效应”（所有模型p > 0.20）。
重症监护病房可能存在“七月效应”，但结果不一。大多数生存模型显示出统计学显著差异，但自主循环恢复和神经学结局的二次分析并未支持这一点。我们发现医院内心脏骤停患者在急诊科或内科/外科病房不存在“七月效应”。
