title: The "July Effect": A Look at July Medical Admissions in Teaching Hospitals.
abstract: OBJECTIVE
  We examined the effect of admission for myocardial infarction, heart failure, or pneumonia during the first academic quarter compared with all other quarters in teaching versus nonteaching hospitals on length of stay, cost, and mortality.
  
  
  METHODS
  Using data 2011 Nationwide Inpatient Sample, multivariable modeling with an interaction term was used to test teaching hospital effect by academic quarter. Logistic regression was used for mortality and log-transformed linear models for cost and length of stay.
  
  
  RESULTS
  Charlson Index scores were similar in teaching and nonteaching hospitals. Patients admitted to teaching hospitals for myocardial infarction in the first quarter had a higher risk-adjusted mortality (1.217; confidence interval, 1.147-1.290) than those admitted to a nonteaching hospital during the same quarter (0.849; confidence interval, 0.815-0.885). Mean cost heart failure admissions averaged $584 more, and the mean length of stay was longer (0.10;P= .0127), during the first academic quarter. These effects were not present for quarters 2 through 4.
  
  
  CONCLUSIONS
  This study suggests small increases in mortality among patients admitted with myocardial infarction in the first academic quarter compared with all other quarters in teaching versus nonteaching hospitals. Increased cost and longer stay were seen for those admitted with heart failure.
authors.affiliation: From the Department of Family Medicine, Medical University of South Carolina, Charleston (LDM); the Department of Community Health and Family Medicine, University of Florida, Gainesville (MP, PJC); and the Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston (KNS). durham@musc.edu.
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Mims
authors.affiliation: From the Department of Family Medicine, Medical University of South Carolina, Charleston (LDM); the Department of Community Health and Family Medicine, University of Florida, Gainesville (MP, PJC); and the Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston (KNS).
authors.forename: Maribeth
authors.initials: M
authors.lastname: Porter
authors.affiliation: From the Department of Family Medicine, Medical University of South Carolina, Charleston (LDM); the Department of Community Health and Family Medicine, University of Florida, Gainesville (MP, PJC); and the Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston (KNS).
authors.forename: Kit N
authors.initials: KN
authors.lastname: Simpson
authors.affiliation: From the Department of Family Medicine, Medical University of South Carolina, Charleston (LDM); the Department of Community Health and Family Medicine, University of Florida, Gainesville (MP, PJC); and the Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston (KNS).
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Carek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004503:Education, Medical, Graduate; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000401:mortality / Q000628:therapy; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data; D011014:Pneumonia / Q000401:mortality / Q000628:therapy; D011787:Quality of Health Care / Q000706:statistics & numerical data*
keywords: Heart Failure; Hospitalization; Hospitals; Teaching; Length of Stay; Linear Models; Logistic Models; Myocardial Infarction; Pneumonia