scholarly journals Outcomes of a Care Coordination Guardianship Intervention for Adults with Severe Mental Illness: An Interrupted Time Series Analysis

2019 ◽  
Vol 47 (3) ◽  
pp. 468-474
Author(s):  
Eliot Levine ◽  
Catherine Jett ◽  
Jeremiah Johnson ◽  
Heather Connors
Keyword(s):  
Time Series ◽  
Mental Illness ◽  
Intensive Care ◽  
Time Series Analysis ◽  
Severe Mental Illness ◽  
Care Coordination ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Legal Outcomes

AbstractThis study investigates the impacts of an intensive care coordination intervention for adults with severe mental illness who have guardians. Program impacts on medical and legal outcomes were assessed using interrupted time series analysis. Program participation was associated with statistically significant reductions in the level and trend of psychiatric hospitalizations, number of days in psychiatric hospitals, emergency room visits, and arrests. Days incarcerated did not change significantly. The decrease in medical and legal outcomes may be associated with decreased spending on these services. The program and other intensive care coordination interventions for this population warrant further replication and research.

scholarly journals A Multicenter Pragmatic Interrupted Time Series Analysis of Chlorhexidine Gluconate Bathing in Community Hospital Intensive Care Units

2016 ◽  
Vol 37 (7) ◽  
pp. 791-797 ◽  
Author(s):  
Kristen V. Dicks ◽  
Eric Lofgren ◽  
Sarah S. Lewis ◽  
Rebekah W. Moehring ◽  
Daniel J. Sexton ◽  
...  
Keyword(s):  
Time Series ◽  
Intensive Care ◽  
Time Series Analysis ◽  
Bloodstream Infections ◽  
Interrupted Time Series ◽  
Incidence Rates ◽  
Chlorhexidine Gluconate ◽  
Interrupted Time Series Analysis ◽  
Icu Patients ◽  
Series Analysis

OBJECTIVETo determine whether daily chlorhexidine gluconate (CHG) bathing of intensive care unit (ICU) patients leads to a decrease in hospital-acquired infections (HAIs), particularly infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE).DESIGNInterrupted time series analysis.SETTINGThe study included 33 community hospitals participating in the Duke Infection Control Outreach Network from January 2008 through December 2013.PARTICIPANTSAll ICU patients at study hospitals during the study period.METHODSOf the 33 hospitals, 17 hospitals implemented CHG bathing during the study period, and 16 hospitals that did not perform CHG bathing served as controls. Primary pre-specified outcomes included ICU central-line–associated bloodstream infections (CLABSIs), primary bloodstream infections (BSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infections (CAUTIs). MRSA and VRE HAIs were also evaluated.RESULTSChlorhexidine gluconate (CHG) bathing was associated with a significant downward trend in incidence rates of ICU CLABSI (incidence rate ratio [IRR], 0.96; 95% confidence interval [CI], 0.93–0.99), ICU primary BSI (IRR, 0.96; 95% CI, 0.94–0.99), VRE CLABSIs (IRR, 0.97; 95% CI, 0.97–0.98), and all combined VRE infections (IRR, 0.96; 95% CI, 0.93–1.00). No significant trend in MRSA infection incidence rates was identified prior to or following the implementation of CHG bathing.CONCLUSIONSIn this multicenter, real-world analysis of the impact of CHG bathing, hospitals that implemented CHG bathing attained a decrease in ICU CLABSIs, ICU primary BSIs, and VRE CLABSIs. CHG bathing did not affect rates of specific or overall infections due to MRSA. Our findings support daily CHG bathing of ICU patients.Infect Control Hosp Epidemiol 2016;37:791–797

Mortality, Morbidity, and Costs After Implementation of a Vasopressin Guideline in Medical Intensive Care Patients With Septic Shock: An Interrupted Time Series Analysis

2019 ◽  
Vol 54 (4) ◽  
pp. 314-321
Author(s):  
Seth R. Bauer ◽  
Gretchen L. Sacha ◽  
Anita J. Reddy
Keyword(s):  
Septic Shock ◽  
Time Series ◽  
Intensive Care ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Absolute Difference ◽  
Interrupted Time Series Analysis ◽  
Icu Mortality ◽  
Series Analysis ◽  
Norepinephrine Dose

Background: Vasopressin decreases vasopressor requirements in patients with septic shock. However, the optimal norepinephrine dose for initiation or cessation of vasopressin is unclear. Objective: Analyze monthly intensive care unit (ICU) mortality rates 1 year preimplementation and postimplementation of a guideline suggesting a norepinephrine dose of 50 µg/min or more for initiation of vasopressin and early cessation of vasopressin. Methods: This retrospective quasi-experimental study included adult patients with septic shock admitted to the medical ICU of a tertiary care medical center over 2 years. Time periods were evaluated with interrupted time series analysis. Results: A total of 1148 patients were included: 573 patients preguideline and 575 patients postguideline. Group characteristics were well balanced at baseline, except patients postguideline had higher sequential organ failure assessment scores. Postguideline, fewer patients were initiated on vasopressin (305 [53.2%] vs 217 [37.7%], absolute difference −15.5% [95% CI −21.2% to −9.8%]), and the norepinephrine dose at vasopressin initiation was higher (median 25 [interquartile range 18, 40] µg/min vs 40 [22, 52] µg/min; median difference 15 [95% CI 11 to 19] µg/min; P < 0.01). After guideline implementation, there was no evidence for a difference in ICU mortality rate slope (slope change 0.07% [95% CI −0.8% to 1.0%] per month; P 0.87), but the vasoactive cost level decreased by US$183 (95% CI −US$327 to −US$39) per patient immediately after implementation. Conclusion and Relevance: Implementation of a guideline suggesting a high norepinephrine dose threshold for vasopressin initiation and early vasopressin cessation in patients with septic shock appears to be safe and may decrease vasoactive costs.

scholarly journals Does admission prevalence change after reconfiguration of inpatient services? An interrupted time series analysis of the impact of reconfiguration in five centres

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joanne Martin ◽  
Edwin Amalraj Raja ◽  
Steve Turner
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Emergency Admission ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Emergency Admissions ◽  
Series Analysis ◽  
Inpatient Services ◽  
The Impact ◽  
Admission Prevalence

Abstract Background Service reconfiguration of inpatient services in a hospital includes complete and partial closure of all emergency inpatient facilities. The “natural experiment” of service reconfiguration may give insight into drivers for emergency admissions to hospital. This study addressed the question does the prevalence of emergency admission to hospital for children change after reconfiguration of inpatient services? Methods There were five service reconfigurations in Scottish hospitals between 2004 and 2018 where emergency admissions to one “reconfigured” hospital were halted (permanently or temporarily) and directed to a second “adjacent” hospital. The number of emergency admissions (standardised to /1000 children in the regional population) per month to the “reconfigured” and “adjacent” hospitals was obtained for five years prior to reconfiguration and up to five years afterwards. An interrupted time series analysis considered the association between reconfiguration and admissions across pairs comprised of “reconfigured” and “adjacent” hospitals, with adjustment for seasonality and an overall rising trend in admissions. Results Of the five episodes of reconfiguration, two were immediate closure, two involved closure only to overnight admissions and one with overnight closure for a period and then closure. In “reconfigured” hospitals there was an average fall of 117 admissions/month [95% CI 78, 156] in the year after reconfiguration compared to the year before, and in “adjacent” hospitals admissions rose by 82/month [32, 131]. Across paired reconfigured and adjacent hospitals, in the months post reconfiguration, the overall number of admissions to one hospital pair slowed, in another pair admissions accelerated, and admission prevalence was unchanged in three pairs. After reconfiguration in one hospital, there was a rise in admissions to a third hospital which was closer than the named “adjacent” hospital. Conclusions There are diverse outcomes for the number of emergency admissions post reconfiguration of inpatient facilities. Factors including resources placed in the community after local reconfiguration, distance to the “adjacent” hospital and local deprivation may be important drivers for admission pathways after reconfiguration. Policy makers considering reconfiguration might consider a number of factors which may be important determinants of admissions post reconfiguration.

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