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Research Letter
September 2016

Assessment of Patient-Reported Experiences of Hospital Care and the July Phenomenon

Author Affiliations
  • 1Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
  • 2Department of Surgery, Mayo Clinic, Rochester, Minnesota
JAMA Surg. 2016;151(9):879-880. doi:10.1001/jamasurg.2016.0402

A recent article1 suggested that the influx of new surgical residents at the beginning of the academic year is not associated with worse outcomes among patients undergoing emergency general surgery, contrary to the widely believed July phenomenon. In the modern era of surgical education, other studies have also supported the authors’ findings across other specialties including orthopedics,2 neurosurgery,3 and acute care surgery.4 We hypothesized that patient-centered outcomes are also not associated with the known influx of new surgical residents in July and August.

After obtaining approval from the Mayo Clinic Institutional Review Board as a minimal-risk study not requiring informed consent, all adult inpatient surgical patients who met criteria for the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey sampling in 2013 or 2014 at a single academic medical center were identified retrospectively in 2015, and those with returned surveys were included. The HCAHPS outcomes measures were constructed in accordance with the published Centers for Medicare and Medicaid Services Star Rating method and dichotomized for analysis (high vs low).5 Multivariable logistic regression was used to replicate Centers for Medicare and Medicaid Services case-mix adjustment (education, overall health status, language, and age), with additional adjustment by patient complexity (by diagnosis related group code), emergent admission, cancer diagnosis, patient sex, and surgical specialty.