scholarly journals 87 Effects of Community Falls Prevention Service Closure on ICD-10 Coded Fracture Rates in Older People: An Interrupted Time Series Approach

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i28-i29
Author(s):  
A McCarthy ◽  
P McMeekin ◽  
G Anderson ◽  
S McCarthy ◽  
S W Parry
Keyword(s):  
Time Series ◽  
Service Provision ◽  
Secondary Care ◽  
Balance Training ◽  
Interrupted Time Series ◽  
Falls Prevention ◽  
Initial Increase ◽  
Case Ascertainment ◽  
Icd 10 ◽  
Service Closure

Abstract Introduction Guidelines on falls prevention recommend case ascertainment based on opportunistic case ascertainment and referral in those who have fallen. In October 2009 we implemented a novel multidisciplinary, multifactorial falls, syncope and dizziness service with enhanced case-ascertainment through proactive, primary care-based screening for associated risk factors. In addition to comprehensive geriatric assessment, 25% of 4032 service participants underwent strength and balance training. The baseline outcomes have been previously reported.1 Funding was withdrawn, and the service closed on 31/01/2014. We examined the effect of service-closure on fractures presenting to secondary care with and without the service running. Methods An interrupted time series method was used. ICD-10 coded fracture numbers attending secondary care were determined (Hospital Episode Statistics from 01/02/2012-31/05/2017) for all North Tyneside residents ≥60 years at the time of service closure, including 25-months with, and 40-months without, service provision. Results There was a 0.9% (p=0.018) monthly reduction in falls over 25-months of service provision which increased during the winter months of a 9.8% (p=0.015) increase. In the month following the service closure there was an initial increase in fractures of 8.5% (p=0.231), followed by an increase in the monthly time trend of 1% (p=0.018). This resulted in a post-service monthly increase in fractures of 0.1%, an estimated extra 625 fractures over the 40-month post-service cessation period. At an average £8600 per fracture, the estimated cost may have been £5,375,000. Conclusions In this naturalistic experiment, following an initial drop in fractures, disinvestment in this service resulted in a rise in elders’ fractures presenting to secondary care. The closure of the service may have had a large unintended cost, averaging £1.5 million annually, versus annual running costs of £220,000. Further research is needed to control for patient-level characteristics and to establish the cost-effectiveness of the service.

scholarly journals 74 Effects of Community Falls Prevention Service Closure on Ischaemic Heart Disease Attendances in Secondary Care: An Interrupted Time Series Approach

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i24-i24
Author(s):  
A McCarthy ◽  
P McMeekin ◽  
G Anderson ◽  
S McCarthy ◽  
S W Parry
Keyword(s):  
Time Series ◽  
Heart Disease ◽  
Ischaemic Heart Disease ◽  
Service Provision ◽  
Secondary Care ◽  
Interrupted Time Series ◽  
Falls Prevention ◽  
Initial Increase ◽  
Time Series Approach ◽  
Service Closure

Abstract Background In 2009 we implemented a novel multidisciplinary, multifactorial falls, syncope and dizziness service model utilising proactive, primary care-based screening (≥60 years). Participants underwent comprehensive geriatric assessment, while 25% of the 4032 service participants had exercise training. All had additional lifestyle advice on exercise, alcohol intake, weight loss and smoking cessation. The preliminary outcomes of this approach have been previously reported, with occult atrial fibrillation, murmurs, ECG-evident ischaemic heart disease (IHD) etc reported to GPs for further action.1 Funding was withdrawn and the service closed on 31/01/2014. We examined IHD secondary care attendances with and without service provision. Methods Patients: North Tyneside residents ≥60 years at time of closure of the service in January 2014, who were presented acutely to secondary care with IHD using an interrupted time series method. ICD-10 coded IHD numbers were determined (Hospital Episode Statistics from 01/02/2012[date of a change in coding compared to service commencement in 2009] until 31/05/2017) including 25-months with, and 40-months without, service provision. Results The Table summarises the change in IHD +/- service provision; there was a significant reduction in IHD non-elective admissions during both time series’, but the reduction was significantly lower without service provision. In addition, immediately following the service closure there was an initial increase in IHD complications of 18.4% (p=0.059) followed by an increase in the time trend of 2.7% (p=0.029), resulting in a 0.6% post-service monthly reduction in IHD complications. Conclusions Disinvestment in this service resulted in a slowdown in the underlying reduction of IHD diagnoses in secondary care. However, further research is needed to control for patient-level characteristics, the economic impact and to look at the effect of the service on other cardiovascular diseases. Reference 1. Parry SW. JAGS 2016; 64 (11):2368–2373.

Impact of ICD-9 to ICD-10 Coding Transition on Prevalence Trends in Neurology

2021 ◽  
Vol 11 (5) ◽  
pp. e612-e619
Author(s):  
Ali G. Hamedani ◽  
Leah Blank ◽  
Dylan P. Thibault ◽  
Allison W. Willis
Keyword(s):  
Time Series ◽  
Status Epilepticus ◽  
Interrupted Time Series ◽  
International Classification Of Diseases ◽  
Disease Prevalence ◽  
Rate Of Change ◽  
International Classification ◽  
Classification Of Diseases ◽  
Icd 10

ObjectiveTo determine the effect of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) coding transition on the point prevalence and longitudinal trends of 16 neurologic diagnoses.MethodsWe used 2014–2017 data from the National Inpatient Sample to identify hospitalizations with one of 16 common neurologic diagnoses. We used published ICD-9-CM codes to identify hospitalizations from January 1, 2014, to September 30, 2015, and used the Agency for Healthcare Research and Quality's MapIt tool to convert them to equivalent ICD-10-CM codes for October 1, 2015–December 31, 2017. We compared the prevalence of each diagnosis before vs after the ICD coding transition using logistic regression and used interrupted time series regression to model the longitudinal change in disease prevalence across time.ResultsThe average monthly prevalence of subarachnoid hemorrhage was stable before the coding transition (average monthly increase of 4.32 admissions, 99.7% confidence interval [CI]: −8.38 to 17.01) but increased after the coding transition (average monthly increase of 24.32 admissions, 99.7% CI: 15.71–32.93). Otherwise, there were no significant differences in the longitudinal rate of change in disease prevalence over time between ICD-9-CM and ICD-10-CM. Six of 16 neurologic diagnoses (37.5%) experienced significant changes in cross-sectional prevalence during the coding transition, most notably for status epilepticus (odds ratio 0.30, 99.7% CI: 0.26–0.34).ConclusionsThe transition from ICD-9-CM to ICD-10-CM coding affects prevalence estimates for status epilepticus and other neurologic disorders, a potential source of bias for future longitudinal neurologic studies. Studies should limit to 1 coding system or use interrupted time series models to adjust for changes in coding patterns until new neurology-specific ICD-9 to ICD-10 conversion maps can be developed.

scholarly journals The Medium-Term Impact of COVID-19 Lockdown on Referrals to Secondary Care Mental Health Services: A Controlled Interrupted Time Series Study

2020 ◽  
Vol 11 ◽  
Author(s):  
Shanquan Chen ◽  
Rui She ◽  
Pei Qin ◽  
Anne Kershenbaum ◽  
Emilio Fernandez-Egea ◽  
...  
Keyword(s):  
Mental Health ◽  
Time Series ◽  
Secondary Care ◽  
Interrupted Time Series ◽  
Service Planning ◽  
Chronic Obstructive ◽  
Medium Term ◽  
Health Crisis ◽  
Time Series Study ◽  
Series Study

To date, there is a paucity of information regarding the effect of COVID-19 or lockdown on mental disorders. We aimed to quantify the medium-term impact of lockdown on referrals to secondary care mental health clinical services. We conducted a controlled interrupted time series study using data from Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), UK (catchment population ~0.86 million). The UK lockdown resulted in an instantaneous drop in mental health referrals but then a longer-term acceleration in the referral rate (by 1.21 referrals per day per day, 95% confidence interval [CI] 0.41–2.02). This acceleration was primarily for urgent or emergency referrals (acceleration 0.96, CI 0.39–1.54), including referrals to liaison psychiatry (0.68, CI 0.35–1.02) and mental health crisis teams (0.61, CI 0.20–1.02). The acceleration was significant for females (0.56, CI 0.04–1.08), males (0.64, CI 0.05–1.22), working-age adults (0.93, CI 0.42–1.43), people of White ethnicity (0.98, CI 0.32–1.65), those living alone (1.26, CI 0.52–2.00), and those who had pre-existing depression (0.78, CI 0.19–1.38), severe mental illness (0.67, CI 0.19–1.15), hypertension/cardiovascular/cerebrovascular disease (0.56, CI 0.24–0.89), personality disorders (0.32, CI 0.12–0.51), asthma/chronic obstructive pulmonary disease (0.28, CI 0.08–0.49), dyslipidemia (0.26, CI 0.04–0.47), anxiety (0.21, CI 0.08–0.34), substance misuse (0.21, CI 0.08–0.34), or reactions to severe stress (0.17, CI 0.01–0.32). No significant post-lockdown acceleration was observed for children/adolescents, older adults, people of ethnic minorities, married/cohabiting people, and those who had previous/pre-existing dementia, diabetes, cancer, eating disorder, a history of self-harm, or intellectual disability. This evidence may help service planning and policy-making, including preparation for any future lockdown in response to outbreaks.

scholarly journals Interrupted time series design to evaluate the effect of the ICD-9-CM to ICD-10-CM coding transition on injury hospitalization trends

2018 ◽  
Vol 5 (1) ◽  
Author(s):  
Svetla Slavova ◽  
Julia F. Costich ◽  
Huong Luu ◽  
Judith Fields ◽  
Barbara A. Gabella ◽  
...  
Keyword(s):  
Time Series ◽  
Interrupted Time Series ◽  
Series Design ◽  
Time Series Design ◽  
Icd 10 ◽  
Interrupted Time Series Design

scholarly journals Impact of ICD-9-CM to ICD-10-CM coding transition on trauma hospitalization trends among young adults in 12 states

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Yuri V. Sebastião ◽  
Gregory A. Metzger ◽  
Deena J. Chisolm ◽  
Henry Xiang ◽  
Jennifer N. Cooper
Keyword(s):  
Time Series ◽  
Young Adults ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Interrupted Time Series ◽  
Positive Trend ◽  
Level Of Evidence ◽  
Severity Of Injury ◽  
Icd 10 ◽  
The Impact

Abstract Background We aimed to estimate the impact of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding transition on traumatic injury-related hospitalization trends among young adults across a geographically and demographically diverse group of U.S. states. Methods Interrupted time series analyses were conducted using statewide inpatient databases from 12 states and including traumatic injury-related hospitalizations in adults aged 19–44 years in 2011–2017. Segmented regression models were used to estimate the impact of the October 2015 coding transition on external cause of injury (ECOI) completeness (percentage of hospitalizations with a documented ECOI code) and on population-level rates of injury-related hospitalizations by nature, intent, mechanism, and severity of injury. Results The transition to ICD-10-CM was associated with a drop in ECOI completion in the transition month (− 3.7%; P < .0001), but there was no significant change in the positive trend in ECOI completion from the pre- to post-transition periods. There were significant increases post-transition in the measured rates of hospitalization for traumatic brain injury (TBI), unintentional injury, mild injury (injury severity score (ISS) < 9), and injuries caused by drowning, firearms, machinery, other pedestrian, suffocation, and unspecified mechanism. Conversely, there were significant decreases in October 2015 in the rates of hospitalization for assault, injuries of undetermined intent, injuries of moderate severity (ISS 9–15), and injuries caused by fire/burn, other pedal cyclist, other transportation, natural/environmental, and other specified mechanism. A significant increase in the percentage of hospitalizations classified as resulting from severe injury (ISS > 15) was observed when the general equivalence mapping maximum severity method for converting ICD-10-CM codes to ICD-9-CM codes was used. State-specific results for the outcomes of ECOI completion and TBI-related hospitalization rates are provided in an online supplement. Conclusions The U.S. transition from ICD-9-CM to ICD-10-CM coding led to a significant decrease in ECOI completion and several significant changes in measured rates of injury-related hospitalizations by injury intent, mechanism, nature, and severity. The results of this study can inform the design and analysis of future traumatic injury-related health services research studies that use both ICD-9-CM and ICD-10-CM coded data. Level of evidence II (Interrupted Time Series)

scholarly journals What happens when performance-based financing meets free healthcare? Evidence from an interrupted time-series analysis

2020 ◽  
Vol 35 (8) ◽  
pp. 906-917
Author(s):  
Naasegnibe Kuunibe ◽  
Julia Lohmann ◽  
Michael Hillebrecht ◽  
Hoa Thi Nguyen ◽  
Gauthier Tougri ◽  
...  
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Service Provision ◽  
Health Financing ◽  
Interrupted Time Series ◽  
Healthcare Policy ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Performance Based Financing ◽  
Free Healthcare

Abstract In spite of the wide attention performance-based financing (PBF) has received over the past decade, no evidence is available on its impacts on quantity and mix of service provision nor on its interaction with parallel health financing interventions. Our study aimed to examine the PBF impact on quantity and mix of service provision in Burkina Faso, while accounting for the parallel introduction of a free healthcare policy. We used Health Management Information System data from 838 primary-level health facilities across 24 districts and relied on an interrupted time-series analysis with independent controls. We placed two interruptions, one to account for PBF and one to account for the free healthcare policy. In the period before the free healthcare policy, PBF produced significant but modest increases across a wide range of maternal and child services, but a significant decrease in child immunization coverage. In the period after the introduction of the free healthcare policy, PBF did not affect service provision in intervention compared with control facilities, possibly indicating a saturation effect. Our findings indicate that PBF can produce modest increases in service provision, without altering the overall service mix. Our findings, however, also indicate that the introduction of other health financing reforms can quickly crowd out the effects produced by PBF. Further qualitative research is required to understand what factors allow healthcare providers to increase the provision of some, but not all services and how they react to the joint implementation of PBF and free health care.

scholarly journals Chilean mortality due to STEMI: analysis of a public policy using interrupted time series

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
G Nuñez Muñoz
Keyword(s):  
Time Series ◽  
Interrupted Time Series ◽  
P Value ◽  
Years Of Life Lost ◽  
Interrupted Time Series Analysis ◽  
Hospital Discharges ◽  
Post Intervention ◽  
St Segment Elevation ◽  
St Segment ◽  
Icd 10

Abstract Issue To the end of 1990s, ST-segment elevation myocardial infarction (STEMI), along with other causes, led the causes of death in Chile. Therefore, at the beginning of 2000s, the explicit health guarantees policies were created, including the treatment of STEMI, which was implemented in first quarter of 2005, generating a series of benefits that seek to improve people's survival. However, there are few studies that show the effectiveness of interventions at the level of morbimortality, given the difficulty in database (DB) collection. Description of the problem The objective is to determine if the policy implemented was able to reduce the mortality associated for STEMI, evidenced in the number of cases and potential years of life lost (PYLL). The public DB of Hospital Discharges (HD) and Deaths of Chile during the periods 1997-2017 were analyzed. ICD-10 codes were identified for STEMI. An interrupted time series analysis (ITSA) was performed with Newey-West regression adjusted according to autocorrelation, using as intervention the start of the STEMI policy, both in annual and quarterly series. For PYLL calculation, life expectancies by sex, were used, available on the website of the National Institute of Statistics of Chile. The data was analyzed with Stata v15.1. Results 27807004 HD were recorded, of which 143061 were due to STEMI, 10.9% died at the in-hospital. Regarding deaths, 1586731 occurred, of which 6.37% were secondary to STEMI. When performing ITSA, for deaths it was observed that there was a significant increase in post-intervention cases (p-value &lt;0.05), PYLL increased post intervention (p-value 0.001). HD showed a decrease in post-intervention mortality cases (p-value &lt;0.01) and PYLL showed no significative changes with respect to the pre-intervention time. Lessons Globally, the focus on treatment has not allowed to reduce STEMI mortality. Prevention is the key to treat Social Transmission Diseases Key messages ITSA is a powerful tool to analyze interventions. Prevent and treat.

scholarly journals Interrupted time series analysis of cannabis coding in Colorado during the ICD-10-CM transition

2021 ◽  
Vol 27 (Suppl 1) ◽  
pp. i66-i70
Author(s):  
Katelyn E Hall ◽  
Hannah Yang ◽  
DeLayna Goulding ◽  
Elyse Contreras ◽  
Katherine A James
Keyword(s):  
Time Series ◽  
Adverse Effects ◽  
Interrupted Time Series ◽  
International Classification Of Diseases ◽  
Cannabis Use ◽  
Negative Slope ◽  
Interrupted Time Series Analysis ◽  
Hospital Discharges ◽  
Icd 10 ◽  
Cannabis Use Disorders

The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), implemented in 2015, has more codes than ICD-9-CM for events involving cannabis. We examined cannabis indicator trends across the transition from ICD-9-CM to ICD-10-CM in Colorado, where state law regulates adult cannabis use. Using 2011 to 2018 data from hospital and emergency department (ED) discharges, we calculated monthly rates per 1000 discharges for two indicators: (1) cannabis use disorders and (2) poisoning and adverse effects of psychodysleptics. Immediate, point-of-transition (level) and gradual, post-transition (slope) changes across the ICD-9-CM to ICD-10-CM transition were tested using interrupted time series models adjusted for legalisation, seasonality and autocorrelation. We observed a level increase and slope increase in the rate of ED discharges with cannabis use disorders. Hospital discharges with cannabis use disorders had a negative slope change after the transition and no level change. ED discharges with poisoning and adverse effects of psychodysleptics showed an increase in slope after the transition. No effects of the transition were observed on hospital discharges with poisoning and adverse effects of psychodysleptics. Shifts in the level and slope of cannabis indicator rates after implementation of the new coding scheme suggest the use of caution when interpreting trends spanning the ICD-9-CM to ICD-10-CM transition.

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