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

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 <0.05), PYLL increased post intervention (p-value 0.001). HD showed a decrease in post-intervention mortality cases (p-value <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.

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

Injury Prevention ◽

10.1136/injuryprev-2019-043511 ◽

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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The Impact of the Change in Payment System for German Psychiatric Clinics on Treatment Success: An Interrupted Time Series Analysis

Das Gesundheitswesen ◽

10.1055/a-0828-7504 ◽

2019 ◽

Vol 82 (06) ◽

pp. 559-567

Author(s):

Christina Niedermeier ◽

Andrea Barrera ◽

Eva Esteban ◽

Ivana Ivandic ◽

Carla Sabariego

Keyword(s):

Time Series ◽

Negative Impact ◽

Treatment Success ◽

Interrupted Time Series ◽

Sensitivity Analyses ◽

Interrupted Time Series Analysis ◽

Post Intervention ◽

Intervention Point ◽

The Impact ◽

New System

Abstract Background In Germany a new reimbursement system for psychiatric clinics was proposed in 2009 based on the § 17d KHG Psych-Entgeltsystem. The system can be voluntary implemented by clinics since 2013 but therapists are frequently afraid it might affect treatment negatively. Objectives To evaluate whether the new system has a negative impact on treatment success by analysing routinely collected data in a Bavarian clinic. Material and methods Aggregated data of 1760 patients treated in the years 2007–2016 was analysed with segmented regression analysis of interrupted time series to assess the effects of the system on treatment success, operationalized with three outcome variables. A negative change in level after a lag period was hypothesized. The robustness of results was tested by sensitivity analyses. Results The percentage of patients with treatment success tends to increase after the new system but no significant change in level was observed. The sensitivity analyses corroborate results for 2 outcomes but when the intervention point was shifted, the positive change in level for the third outcome became significant. Conclusions Our initial hypothesis is not supported. However, the sensitivity analyses disclosed uncertainties and our study has limitations, such as a short observation time post intervention. Results are not generalizable as data of a single clinic was analysed. Nevertheless, we show the importance of collecting and analysing routine data to assess the impact of policy changes on patient outcomes.

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Effects of the implementation of a hand hygiene education program among ICU professionals: an interrupted time-series analysis

Jornal Brasileiro de Pneumologia ◽

10.1590/1806-3713/e20180152 ◽

2019 ◽

Vol 45 (5) ◽

Author(s):

Diana Marcela Prieto Romero ◽

Maycon Moura Reboredo ◽

Edimar Pedrosa Gomes ◽

Cristina Martins Coelho ◽

Maria Aparecida Stroppa de Paula ◽

...

Keyword(s):

Time Series ◽

Hand Hygiene ◽

Education Program ◽

Hand Hygiene Compliance ◽

Interrupted Time Series ◽

Interrupted Time Series Analysis ◽

Post Intervention ◽

Intervention Phase ◽

Hygiene Compliance ◽

Hygiene Education

ABSTRACT Objective: To evaluate the effects that a hand hygiene education program has on the compliance of health professionals in an ICU. Methods: This was a quasi-experimental study with an interrupted time-series design, conducted over a 12-month period: the 5 months preceding the implementation of a hand hygiene education program (baseline period); the 2 months of the intensive (intervention) phase of the program; and the first 5 months thereafter (post-intervention phase). Hand hygiene compliance was monitored by one of the researchers, unbeknownst to the ICU team. The primary outcome measure was the variation in the rate of hand hygiene compliance. We also evaluated the duration of mechanical ventilation (MV), as well as the incidence of ventilator-associated pneumonia (VAP) at 28 days and 60 days, together with mortality at 28 days and 60 days. Results: On the basis of 959 observations, we found a significant increase in hand hygiene compliance rates-from 31.5% at baseline to 65.8% during the intervention phase and 83.8% during the post-intervention phase, corresponding to prevalence ratios of 2.09 and 2.66, respectively, in comparison with the baseline rate (p < 0.001). Despite that improvement, there were no significant changes in duration of MV, VAP incidence (at 28 or 60 days), or mortality (at 28 or 60 days). Conclusions: Our findings indicate that a hand hygiene education program can increase hand hygiene compliance among ICU professionals, although it appears to have no impact on VAP incidence, duration of MV, or mortality.

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The impact of China’s lockdown policy on the incidence of CoVID-19: An Interrupted time series analysis

10.21203/rs.3.rs-32944/v1 ◽

2020 ◽

Author(s):

Mooketsi Molefi ◽

John Tlhakanelo ◽

Thabo Phologolo ◽

Shimeles G. Hamda ◽

Tiny Masupe ◽

...

Keyword(s):

Time Series ◽

Linear Trend ◽

Effective Means ◽

Interrupted Time Series ◽

Ordinary Least Squares ◽

World Health ◽

Least Squares Regression ◽

Interrupted Time Series Analysis ◽

Post Intervention ◽

The Impact

Abstract BackgroundPolicy changes are often necessary to contain the detrimental impact of epidemics such as the coronavirus disease (COVID-19). China imposed strict restrictions on movement on January 23rd, 2020.Interrupted time series methods were used to study the impact of the lockdown on the incidence of COVID-19. MethodsThe number of cases of COVID-19 reported daily from January 12thto March 30th, 2020 were extracted from the World Health Organization (WHO) COVID-19 dashboard ArcGIS® and matched to China’s projected population of 1 408 526 449 for 2020 in order to estimate daily incidences. Data were plotted to reflect daily incidences as data points in the series. A deferred interruption point of 6thFebruary was used to allow a 14-day period of diffusion. The magnitude of change and linear trend analyses were evaluated using the itsafunction with ordinary least-squares regression coefficients in Stata® yielding Newey-West standard errors.ResultsSeventy-eight (78) daily incidence points were used for the analysis, with 11(14.10%) before the intervention. There was a daily increase of 163 cases (β=1.16*10-07, p=0.00) in the pre-intervention period. Although there was no statistically significant drop in the number of cases reported daily in the immediate period following 6thFebruary 2020 when compared to the counterfactual (p=0.832), there was a 241 decrease (β=-1.71*10-07, p=0.00) in cases reported daily when comparing the pre-intervention and post-intervention periods. A deceleration of 78(47%) cases reported daily. ConclusionThe lockdown policy managed to significantly decrease the incidence of CoVID-19 in China. Lockdown provides an effective means of curtailing the incidence of COVID-19.

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England's Lockdown vs. Sweden's Herd Immunity: A Comparison of the Daily New COVID-19 Cases and Related Deaths Using Comparative Interrupted Time Series Analysis

10.1101/2020.08.13.20174706 ◽

2020 ◽

Author(s):

Moaath Mustafa Ali ◽

Yazan Samhouri ◽

Marwa Sabha ◽

Lynna Alnimer

Keyword(s):

Time Series ◽

Time Series Analysis ◽

Herd Immunity ◽

Interrupted Time Series ◽

Interrupted Time Series Analysis ◽

Post Intervention ◽

Series Analysis ◽

Before And After ◽

Rebound Increase ◽

Related Mortality

Background: There is a lack of empirical evidence that lockdowns decrease daily cases of COVID-19 and related mortality compared to herd immunity. England implemented a delayed lockdown on March 23, 2020, but Sweden did not. We aim to examine the effect of lockdown on daily COVID-19 cases and related deaths during the first 100 days post-lockdown. Methods: We compared daily cases of COVID-19 infection and related mortality in England and Sweden before and after lockdown intervention using a comparative-interrupted time series analysis. The period included was from COVID-19 pandemic onset till June 30, 2020. Results: The adjusted-rate of daily COVID-19 infections was eight cases/10,000,000 person higher in England than Sweden before lockdown order (95% CI: 2-14, P=0.01). On the day of intervention (lagged lockdown), England had 693 more COVID-19 cases/10,000,000 person compared to Sweden (95% CI: 467-920, P<0.001). Compared to the pre-intervention period, the adjusted daily confirmed cases rate decreased by 19 cases/ 10,000,000 person compared to Sweden (95% CI: 13-26, P<0.001). There was a rate excess of 1.5 daily deaths/ 10,000,000 person in England compared to Sweden pre-intervention (95% CI: 1-2, P<0.001). The increased mortality rate resulted in 50 excess deaths/ 10,000,000 person related to COVID-19 in England compared to Sweden on the day of lockdown (95% CI: 30-71, P<0.001). Post-intervention, the rate of daily deaths in England decreased by two deaths/ 10,000,000 person compared to Sweden (95% CI: 1-3, P<0.001). During phases one and two of lockdown lifting in England, there was no rebound increase in daily cases or deaths compared to Sweden. Conclusion: The lockdown order implemented in England on March 23, 2020, effectively decreased the daily new cases rate and related mortality compared to Sweden. There was no short-term increase in COVID-19 cases and related-deaths after the phases one and two of the lifting of restrictions in England compared to Sweden. This study provides empirical, comparative evidence that lockdowns slow the spread of COVID-19 in communities compared to herd immunity.

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LB-16. Association Between Universal Face Shield in a Quaternary Care Center and Reduction of SARS-COV2 Infections Among Healthcare Personnel and Hospitalized Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa515.1913 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S851-S851

Author(s):

Vagesh Hemmige ◽

Becky Winterer ◽

Todd Lasco ◽

Bradley Lembcke

Keyword(s):

Time Series ◽

Care Center ◽

Interrupted Time Series ◽

Hospitalized Patients ◽

Healthcare Personnel ◽

Segmented Regression ◽

Intervention Period ◽

Interrupted Time Series Analysis ◽

Post Intervention ◽

The Impact

Abstract Background SARS-COV2 transmission to healthcare personnel (HCP) and hospitalized patients is a significant challenge. Our hospital is a quaternary healthcare system with more than 500 beds and 8,000 HCP. Between April 1 and April 17, 2020, we instituted several infection prevention strategies to limit transmission of SARS-COV2 including universal masking of HCP and patients, surveillance testing every two weeks for high-risk HCP and every week for cluster units, and surveillance testing for all patients on admission and prior to invasive procedures. On July 6, 2020, we implemented universal face shield for all healthcare personnel upon entry to facility. The aim of this study is to assess the impact of face shield policy on SARS-COV2 infection among HCP and hospitalized patients. Figure 1- Interrupted time series Methods The preintervention period (April 17, 2020-July 5, 2020) included implementation of universal face masks and surveillance testing of HCP and patients. The intervention period (July 6, 2020-July 26, 2020) included the addition of face shield to all HCP (for patient encounters and staff-to-staff encounters). We used interrupted time series analysis with segmented regression to examine the effect of our intervention on the difference in proportion of HCP positive for SARS-COV2 (using logistic regression) and HAI (using Poisson regression). We defined significance as p values < 0.05. Results Of 4731 HCP tested, 192 tested positive for SARS-COV2 (4.1%). In the preintervention period, the weekly positivity rate among HCP increased from 0% to 12.9%. During the intervention period, the weekly positivity rate among HCP decreased to 2.3%, with segmented regression showing a change in predicted proportion positive in week 13 (18.0% to 3.7%, p< 0.001) and change in the post-intervention slope on the log odds scale (p< 0.001). A total of 14 HAI cases were identified. In the preintervention period, HAI cases increased from 0 to 5. During the intervention period, HAI cases decreased to 0. There was a change between pre-intervention and post-intervention slope on the log scale was significant (p< 0.01). Conclusion Our study showed that the universal use of face shield was associated with significant reduction in SARS-COV2 infection among HCP and hospitalized patients. Disclosures All Authors: No reported disclosures

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Effect of the Colombian Emergency Department Triage Policy on the timeliness of ED care and the mortality in patients with cerebrovascular attack: A controlled interrupted time series analysis

10.21203/rs.3.rs-55373/v1 ◽

2020 ◽

Author(s):

Carlos Eduardo Vallejo ◽

Daniel Felipe Patiño-Lugo ◽

Daniel Camilo Aguirre-Acevedo ◽

Juan Pablo Acosta

Keyword(s):

Emergency Department ◽

Time Series ◽

Time Series Analysis ◽

Interrupted Time Series ◽

Reperfusion Therapy ◽

Intervention Period ◽

Interrupted Time Series Analysis ◽

Post Intervention ◽

Emergency Department Triage ◽

The City

Abstract Background: Ischemic Cerebrovascular Accident (CVA) is the second cause of death and one of the leading causes of disability in the world. In Colombia, there is a prevalence of 0.16% and a mortality rate of 16.82 deaths per 100,000 inhabitants. This study assessed the Colombian Ministry of Health’s Emergency Department Triage Policy (TP) on the timeliness of hospital care, the mortality, and change in reperfusion therapy of patients with the first episode of an CVA in the Emergency Department (ED) of a hospital in the city of Medellín.Methods: A controlled interrupted time series analysis between January 2011 and November 2017 was performed in one emergency department using segmented regression analysis. The emergency department of other hospital was used as a control. Data were aggregated by month for both ED, including 60 pre-intervention and 23 intervention points.Results: No decrease in the timeliness of care in the ED was found in patients with a stroke after implementing the Colombian Ministry of Health’s TP (12.55 minutes, IC -17.07, 42.17; p: 0.4). The TP intervention produced a level change in the timeliness of care in Triage I and II subgroups, of 28.34 minutes (IC 95% 16.9, 39.79; p valor 0.00), there was no change in the trend. The classification of Triage I and II was more frequent in the post-intervention period. There was evidence of the increase in reperfusion therapy with tissue plasminogen activator (rTPA) in 4% (95% CI – 0.08, - 0.01; p value 0.01). Mortality increased 4% in the post-intervention period without being statistically significant (0.04, IC 95% - 0.08 – 0; p valor 0.06). There were no significant changes in the same outcomes in the control group.Conclusions: The implementation of the triage policy allowed improving the timeliness of ED care only in patients with ischemic CVA classified as Triage I and II, in an Emergency Department in the city of Medellín, Colombia.

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The impact of the social distancing policy on COVID-19 new cases in Iran: insights from an interrupted time series analysis

10.21203/rs.3.rs-25818/v1 ◽

2020 ◽

Author(s):

Mahboubeh Khaton Ghanbari ◽

Meysam Behzadifar ◽

Mohammad Hasan Imani-Nasab ◽

Masoud Behzadifar ◽

Ahad Bakhtiari ◽

...

Keyword(s):

Time Series ◽

Time Series Analysis ◽

Infectious Agent ◽

Interrupted Time Series ◽

P Value ◽

Interrupted Time Series Analysis ◽

Social Distancing ◽

Series Analysis ◽

The Social ◽

The Impact

Abstract Background In late December 2019, a viral outbreak occurred in Wuhan, province of Hubei, People’s Republic of China, and rapidly spread out worldwide. The infectious agent was identified and termed as SARS-CoV-2, responsible of the “coronavirus disease 19” (COVID-19). Due to the lack of vaccines and effective drugs for this disease, many policy- and decision-makers have focused on non-pharmacological methods to prevent and control this disease. Social distancing can be effective in reducing the spread of the outbreak. This study was aimed at assessing the effects of the implementation of the social distancing policy in Iran, one of the countries most affected by the COVID-19. Methods This study was designed as a quasi-experimental study, and was conducted utilizing the interrupted time series analysis (ITSA) approach. Daily data was collected between February 20th 2020 and April 16th 2020. The social distancing policy was launched on March 27th 2020.Results A significant decrease of -288.57 (95% CI: 269.08 (95% CI: -83.37 to -621.55, P-value=0.04) new confirmed cases following the implementation of the social distancing policy was found, corresponding to a daily decrease in the trend of -8.10 (95% CI: -10.02 to -6.19, P-value=0.001). A significant decrease of -24.78 (95% CI: -42.97 to -6.58, P-value=0.01) new deaths following the implementation of the social distancing policy could be found, corresponding to a daily decrease in the trend of -8.10 (95% CI: -10.02 to -6.19, P-value=0.001). Conclusion The growth rate of new cases and deaths from the COVID-19 in Iran has significantly decreased after the implementation of social distancing. By monitoring and implementing this policy in all countries, the burden of COVID-19 can be mitigated.

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Assessing the impact of SIGN 136 on opioid prescribing rates in Scotland: An interrupted time series analysis

10.1101/2021.02.19.21251770 ◽

2021 ◽

Author(s):

Harry L. Hébert ◽

Daniel R. Morales ◽

Nicola Torrance ◽

Blair H. Smith ◽

Lesley A. Colvin

Keyword(s):

Chronic Pain ◽

Time Series ◽

Time Series Analysis ◽

Interrupted Time Series ◽

Relative Reduction ◽

Interrupted Time Series Analysis ◽

Post Intervention ◽

Opioid Prescribing ◽

Prescribing Trends ◽

The Impact

AbstractBackgroundOpioids are used to treat patients with chronic pain, but their long-term use is associated with harms. In December 2013, SIGN 136 was published, providing a comprehensive evidence-based guideline for the assessment and management of chronic pain in ScotlandAimsThis study aimed to examine the impact of SIGN 136 on opioid prescribing trends and costs across the whole of Scotland.MethodsOpioid prescribing data and average cost per item were obtained from Public Health Scotland. An interrupted time series analysis examined the effects of SIGN 136 publication on the number of items prescribed per 1,000 population per quarter for 29 opioids (or opioid-containing combinations) from 2005 to 2019 inclusive. Exploratory analysis was conducted in NHS Tayside and NHS Fife combined and then up-scaled to all 14 NHS Scotland health boards. A similar approach was also used to assess the effect of SIGN 136 on estimated gross ingredient costs per quarter.ResultsAt six years post-intervention there was a relative reduction in opioid prescribing of 18.8% (95% CI: 16.0-21.7) across Scotland. There was also a relative reduction of 22.8% (95%: 14.9-30.1) in gross ingredient cost nationally. Opioid prescribing increased significantly pre-intervention across all 14 NHS Scotland health boards (2.19 items per 1000 population per quarter), followed by a non-significant change in level and a significant negative change in trend post-intervention (−2.69 items per 1000 population per quarter). Similar findings were observed locally in NHS Tayside and NHS Fife.ConclusionsThe publication of SIGN 136 coincided with a statistically significant reduction in opioid prescribing rates in Scotland and suggests that changes in clinical policy are having a positive effect on prescribing practices in primary care. These prescribing trends appear to be in contrast to the UK as a whole.

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Impact of COVID-19 lockdown on emergency asthma admissions and deaths: national interrupted time series analyses for Scotland and Wales

Thorax ◽

10.1136/thoraxjnl-2020-216380 ◽

2021 ◽

pp. thoraxjnl-2020-216380

Author(s):

Gwyneth A Davies ◽

Mohammad A Alsallakh ◽

Shanya Sivakumaran ◽

Eleftheria Vasileiou ◽

Ronan A Lyons ◽

...

Keyword(s):

Time Series ◽

Severe Asthma ◽

Inhaled Corticosteroids ◽

Meta Analysis ◽

Interrupted Time Series ◽

P Value ◽

Interrupted Time Series Analysis ◽

Emergency Admissions ◽

Asthma Exacerbations ◽

The Impact

BackgroundThe COVID-19 pandemic’s impact on people with asthma is poorly understood. We hypothesised that lockdown restrictions were associated with reductions in severe asthma exacerbations requiring emergency asthma admissions and/or leading to death.MethodsUsing data from Public Health Scotland and the Secure Anonymised Information Linkage Databank in Wales, we compared weekly counts of emergency admissions and deaths due to asthma over the first 18 weeks in 2020 with the national averages over 2015–2019. We modelled the impact of instigating lockdown on these outcomes using interrupted time-series analysis. Using fixed-effect meta-analysis, we derived pooled estimates of the overall changes in trends across the two nations. We also investigated trends in asthma-related primary care prescribing and emergency department (ED) attendances in Wales.ResultsLockdown was associated with a 36% pooled reduction in emergency admissions for asthma (incidence rate ratio, IRR: 0.64, 95% CI: 0.49 to 0.83, p value 0.001) across both countries. There was no significant change in asthma deaths (pooled IRR: 0.57, 95% CI: 0.17 to 1.94, p value 0.37). ED asthma attendances in Wales declined during lockdown (IRR: 0.85, 95% CI: 0.73 to 0.99, p value 0.03). A large spike of 121% more inhaled corticosteroids and 133% more oral corticosteroid prescriptions was seen in Wales in the week before lockdown.ConclusionsNational lockdowns were associated with substantial reductions in severe asthma exacerbations leading to hospital admission across both Scotland and Wales, with no corresponding increase in asthma deaths.

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