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It Is OK to Get Sick in July

Eugene C. Rich, MD; Steve Hillson, MD; Bryan Dowd, PhD; Gregory Gifford, PhD; Michael Luxenberg, PhD
JAMA. 1991;265(2):212-213. doi:10.1001/jama.1991.03460020066022.
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To the Editor. —  In his letter of August 1, Blumberg1,2 described the very interesting finding of a July elevation in the mortality rate of teaching hospital patients undergoing nonelective surgery as compared with patients in nonteaching hospitals. While Blumberg's study differs from ours in various respects (eg, surgical patients, patient selection based on procedure, multihospital data for a single year), the most important difference is the focus on a unique effect in July. Our study explored the effects of increasing house-staff experience (as defined by the month of the academic year) on inpatient care, rather than identifying effects isolated to July.3Many changes in patient care occur in July in teaching hospitals that are unrelated to house-staff experience but may affect cost or other outcomes. For example, although physician discontinuity is a common occurrence in teaching hospitals, July is the one month when all house staff change


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