Academic Year-end Changeover and Stroke Outcomes

Abstract

Lower quality of care and poorer outcomes are suspected when new trainees (eg, residents) start in July in teaching hospitals, the so-called "the July effect." We evaluated outcomes and processes of care among patients with an acute ischemic stroke (AIS) admitted in July versus other 11 months of the year. We evaluated AIS patients admitted to 11 tertiary stroke centers in Ontario, Canada between July 1, 2003, and March 31, 2008, identified from the Registry of the Canadian Stroke Network. The main outcomes were death at 30 days and poor functional outcome defined as death at 30 days or a modified Rankin Scale 3-5 at discharge. Of 10,319 eligible AIS patients, 882 (8.5%) were admitted in July and 9437 during the remaining months. There was no difference in baseline characteristics or stroke severity between the 2 groups. Patients admitted in July were less likely to receive thrombolysis (12% vs. 16%; odds ratio (OR), .72; 95% confidence interval (CI), .59-.89), dysphagia screening (64% vs. 68%; OR, .86; 95% CI, .74-.99), and stroke unit care (62% vs. 68%; OR, .78; 95% CI, .68-.90). July admission was not associated with either of higher death at 30 days (adjusted OR, .88; 95% CI, .74-1.03) or poor functional outcome (adjusted OR, .92; 95% CI, .74-1.14). Results remained consistent in the sensitivity analysis by including both July and August as part of the "July effect." AIS patients admitted to tertiary stroke centers during July had similar outcomes despite slightly less frequent thrombolysis and stroke unit care.