‘July effect’ in management and outcomes of patients admitted with pulmonary embolism in the United States, 2016 to 2021
Bibliographic record
Abstract
Background This study sought to assess the outcomes of pulmonary embolism (PE) admissions at teaching and nonteaching hospitals in the month of July, when new trainees begin their training in the United States.Methods During 2016–2021, adult (≥18 years) nonelective admissions with PE, admitted to urban teaching hospitals in the months of May and July, were identified using the National Inpatient Sample and compared to nonteaching admissions. Outcomes of interest included in-hospital mortality, complications, variations in management, total hospitalization costs, and hospitalization duration.Results From January 1, 2016, to December 31, 2021, 164,244 PE admissions were identified in May and July to teaching (76.5%) and nonteaching (23.5%) hospitals. The May and July cohorts had comparable baseline characteristics at both teaching and nonteaching hospitals. The rates of organ failure, noncardiac and cardiac organ support, cardiogenic shock, and cardiac arrest were comparable across all four cohorts. Use of systemic thrombolysis (3.8% vs 3.1%; P = 0.002) and catheter-directed therapies (4.1% vs 3.8%; P = 0.05) were higher in the teaching hospitals in July than in May, but there were no differences in nonteaching hospitals. The cohorts of teaching (3.0% vs 3.3%, P = 0.30) and nonteaching hospitals (2.7% vs 2.2%, P = 0.15) had comparable adjusted in-hospital mortality in May and July. Hospitalization duration, total hospitalization costs, and discharge disposition were comparable in all four cohorts.Conclusion In this large 6-year US analysis, there were no differences in the outcomes of PE admissions to teaching and nonteaching hospitals in the months of May and July, arguing against the ‘July effect.’
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".