Weekend Effect and the July Phenomenon in Patient Safety

描述（由申请人提供）：对医院患者安全的关注集中在不良事件和并发症的原因和流行病学上。先前的研究表明，医院的工作条件可能会影响并发症的发生率。在周末和假日期间，患者需求与所提供的护理之间的差异可能会加剧，此时医院资源减少可能导致患者护理能力下降。另一种情况发生在教学医院，在7月份，新的住院医生开始照顾病人，他们可能缺乏识别和预防并发症的经验。由于缺乏一种可靠的工具来观察具有足够辨别能力的罕见不良事件，这些假设在此之前没有得到检验。我们将使用AHRQ的患者安全指标来查看HCUP的州住院患者数据库中包含的三年出院情况，这些数据来自分布在几个地理区域的几个州。我们将聘请专家顾问就使用哪些指标以及如何最好地使用这些指标提供协助和建议。我们将以两种不同的方式对这些假设进行建模和检验。首先，我们将比较一些并发症的发生率，这些并发症的发生日期和暴露风险的日期很容易确定。亚分析将着眼于特定患者群体的发生率，例如通过急诊室入院的患者，或经过特定程序的患者。其次，我们将对个别选择的PSI进行患者水平的逻辑回归，以评估一周中的哪一天对PSI可能性的影响，控制患者和医院的特征。将进行类似的分析，以测试7月的现象。这项研究对医院如何在周末组织员工有影响，并将告知关于医院是否应该成为完整的7天组织的辩论。如果发现“七月效应”，它将对教学医院在新住院医生开始培训时如何组织工作产生影响。

DESCRIPTION (Provided by Applicant): Concerns over patient safety in hospitals have focussed attention on the causes and epidemiology of adverse events and complications. Prior research suggests that hospital working conditions may impact the rate of complications. One situation where the discrepancy between patient needs and care provided may be accentuated is during weekends and holidays, when reduced hospital resources may lead to reduced capacity for patient care. Another situation, in teaching hospitals, occurs in the month of July, when new house officers assume the care of patients, and may lack the experience for recognizing and preventing complications. These hypotheses have not been tested before due to the absence of a reliable tool to look at rare adverse events with sufficient power of discrimination. We will use AHRQ's Patient Safety Indicators to look at three years of hospital discharges contained in HCUP's State Inpatient Databases from several states distributed over several geographical regions. We will use expert consultants to assist and advise on which indicators to use and how to best use them. We will model and test the hypotheses in two different ways. First, we will compare rates of some complications for which the date of the complication and the date of risk exposure are easily identifiable. Sub-analyses will look at the rates in specific groups of patients, such as patients admitted through the emergency room, or in patients with specific procedures. Second, we will perform patient-level logistic regressions for individually selected PSIs to assess the impact of day of the week on the likelihood of a PSI, controlling for patient and hospital characteristics. A similar analysis will be performed to test for the July phenomenon. This study has implications for how hospitals organize their workforce on weekends, and will inform the debate over whether hospitals should become complete 7-day organizations. If a July effect is found, it will have implications for how teaching hospitals organize their work when new residents begin their training.