scholarly journals Evaluating the impact of a hospital scale-up phase of a quality improvement intervention in Ghana on mortality for children under five

2019 ◽  
Author(s):  
Kavita Singh ◽  
Ilene Speizer ◽  
Pierre M Barker ◽  
Josephine Nana Afrakoma Agyeman-Duah ◽  
Justina Agula ◽  
...  
Keyword(s):  
Time Series ◽  
Quality Improvement ◽  
Infant Mortality ◽  
Scale Up ◽  
Interrupted Time Series ◽  
Post Intervention ◽  
Under Five ◽  
Facility Level ◽  
Provision Of Care ◽  
Southern Ghana

Abstract Objective To evaluate the scale-up phase of a national quality improvement initiative across hospitals in Southern Ghana. Design This evaluation used a comparison of pre- and post-intervention means to assess changes in outcomes over time. Multivariable interrupted time series analyses were performed to determine whether change categories (interventions) tested were associated with improvements in the outcomes. Setting Hospitals in Southern Ghana Participants The data sources were monthly outcome data from intervention hospitals along with program records. Intervention The project used a quality improvement approach whereby process failures were identified by health staff and process changes were implemented in hospitals and their corresponding communities. The three change categories were: timely care-seeking, prompt provision of care and adherence to protocols. Main outcome measures Facility-level neonatal mortality, facility-level postneonatal infant mortality and facility-level postneonatal under-five mortality. Results There were significant improvements for two outcomes from the pre-intervention to the post-intervention phase. Postneonatal infant mortality dropped from 44.3 to 21.1 postneonatal infant deaths per 1000 admissions, while postneonatal under-five mortality fell from 23.1 to 11.8 postneonatal under-five deaths per 1000 admissions. The multivariable interrupted time series analysis indicated that over the long-term the prompt provision of care change category was significantly associated with reduced postneonatal under five mortality (β = −0.0024, 95% CI −0.0051, 0.0003, P < 0.10). Conclusions The reduced postneonatal under-five mortality achieved in this project gives support to the promotion of quality improvement as a means to achieve health impacts at scale.

scholarly journals LO22: Improving the pain experience for children with limb injury: a city-wide quality improvement collaborative

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S14-S14
Author(s):  
J. Thull-Freedman ◽  
T. Williamson ◽  
E. Pols ◽  
A. McFetridge ◽  
S. Libbey ◽  
...  
Keyword(s):  
Time Series ◽  
Quality Improvement ◽  
Time Series Analysis ◽  
Median Time ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Process Measures ◽  
Limb Injury ◽  
Time Period ◽  
Limb Injuries

Introduction: Undertreated pain is known to cause short and long-term harm in children. Limb injuries are a common painful condition in emergency department (ED) patients, accounting for 12% of ED visits by children. Our city has one pediatric ED in a freestanding children’s hospital and 3 general ED’s that treat both adults and children. 68% of pediatric limb injuries in our city are treated in the pediatric ED and 32% are treated in a general ED. A quality improvement (QI) initiative was developed at the children’s hospital ED in April 2015 focusing on “Commitment to Comfort.” After achieving aims at the childrens hospital, a QI collaborative was formed among the pediatric ED and the 3 general ED’s to 1) improve the proportion of children citywide receiving analgesia for limb injuries from 27% to 40% and 2) reduce the median time to analgesia from 37 minutes to 15 minutes, during the time period of April-September, 2016. Methods: Data were obtained from computerized order entry records for children 0-17.99 years visiting any participating ED with a chief complaint of limb injury. Project teams from each site met monthly to discuss aims, develop key driver diagrams, plan tests of change, and share learnings. Implementation strategies were based on the Model for Improvement with PDSA cycles. Patient and family consultation was obtained. Process measures included the proportion of children treated with analgesic medication and time to analgesia; balancing measures were duration of triage and length of stay for limb injury and all patients. Site-specific run charts were used to detect special cause variation. Data from all sites were combined at study end to measure city-wide impact using 2 and interrupted time series analysis. Results: During the 3.5-year time period studied (April 1, 2014-September 30, 2017), there were 45,567 visits to the participating ED’s by children 0-17.99 years with limb injury. All visits were included in analysis. Special cause was detected in run charts of all process measures. Interrupted time series analysis comparing the year prior to implementation at the childrens hospital in April 2015 to the year following completion of implementation at the 3 general hospitals in October 2016 demonstrated that the proportion of patients with limb injury receiving analgesia increased from 27% to 40% (p<0.01), and the median time from arrival to analgesia decreased from 37 to 11 minutes (p<0.01). Balancing measure analysis is in progress. Conclusion: This multisite initiative emphasizing “Commitment to Comfort” was successful in improving pain outcomes for all children with limb injuries seen in city-wide ED’s, and was sustained for one year following implementation. A QI collaborative can be an effective method for spreading improvement. The project team is now spreading the Commitment to Comfort initiative to over 30 rural and regional EDs throughout the province through establishment of a provincial QI collaborative.

scholarly journals On ignoring instead of chasing after coagulation factor VII during warfarin management; an interrupted time series study

Blood ◽  
2021 ◽  
Author(s):  
Alma R. Oskarsdottir ◽  
Brynja R. Gudmundsdottir ◽  
Hulda M. Jensdottir ◽  
Bjorn Flygenring ◽  
Ragnar Palsson ◽  
...  
Keyword(s):  
Time Series ◽  
Coagulation Factor ◽  
Maintenance Phase ◽  
Interrupted Time Series ◽  
Factor Vii ◽  
Segmented Regression ◽  
Post Intervention ◽  
Coagulation Factor Vii ◽  
Monitoring Test ◽  
Time In Range

During warfarin management, prothrombin time (PT) based PT-INR variability is partly due to clinically inconsequential fluctuations of factor (F) VII. The new Fiix-PT and Fiix-normalized ratio (Fiix-NR), unlike PT-INR, is only affected by reduced FII and FX. Starting July 1st 2016 we replaced PT-INR monitoring of warfarin with Fiix-NR in our patients. Using interrupted time series methods, we retrospectively assessed if this affected thromboembolism (TE) and major bleeding (MB) incidence during 12 months prior to and 18 months after the replacement, months 13-18 being predefined as transitional months. The dynamic cohort comprised all our service´s 2,667 maintenance phase warfarin patients managed at any time during the 30 months. Using two-segmented regression, a breakpoint in total TE monthly incidence became evident six months after laboratory monitoring test replacement, followed by 56% reduction in TE incidence (from 2.82% to 1.23% per patient year, P=0.019 by ANOVA). Three-segmented regression found no significant TE incidence trend (slope +0.03) prior to test replacement but during months 13-18 and 19-30 the TE incidence gradually decreased (slope -0.12; R2=0.20;P=0.007). Based on segmented regressions, MB incidence (2.79% ppy) did not differ pre- or post-intervention. Incidence comparison during the 12 month Fiix- and PT-periods confirmed a statistically significant 55-62% reduction in TE. Fiix-monitoring reduced testing, dose adjustments and normalized ratio variability, and prolonged testing intervals and time in range. We conclude that ignoring FVII during Fiix-NR monitoring in real world practice stabilizes the anticoagulant effect of warfarin and associates with major reduction in thromboembolism without increasing bleeding.

Effect of a health system payment and quality improvement programme for tonsillectomy in Ontario, Canada: an interrupted time series analysis

2021 ◽  
pp. bmjqs-2021-013110
Author(s):  
Sanjay Mahant ◽  
Jun Guan ◽  
Jessie Zhang ◽  
Sima Gandhi ◽  
Evan Jon Propst ◽  
...  
Keyword(s):  
Time Series ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Health System ◽  
Interrupted Time Series ◽  
Improve Quality ◽  
Interrupted Time Series Analysis ◽  
Quality Improvement Programme ◽  
Improvement Programme

BackgroundTonsillectomy is among the most common and cumulatively expensive surgical procedures in children, with known variations in quality of care. However, evidence on health system interventions to improve quality of care is limited. The Quality-Based Procedures (QBP) programme in Ontario, Canada, introduced fixed episode hospital payment per tonsillectomy and disseminated a perioperative care pathway. We determined the association of this payment and quality improvement programme with tonsillectomy quality of care.MethodsInterrupted time series analysis of children undergoing elective tonsillectomy at community and children’s hospitals in Ontario in the QBP period (1 April 2014 to 31 December 2018) and the pre-QBP period (1 January 2009 to 31 January 2014) using health administrative data. We compared the age-standardised and sex-standardised rates for all-cause tonsillectomy-related revisits within 30 days, opioid prescription fills within 30 days and index tonsillectomy inpatient admission.Results111 411 children underwent tonsillectomy: 51 967 in the QBP period and 59 444 in the pre-QBP period (annual median number of hospitals, 86 (range 77–93)). Following QBP programme implementation, revisit rates decreased for all-cause tonsillectomy-related revisits (0.48 to −0.18 revisits per 1000 tonsillectomies per month; difference −0.66 revisits per 1000 tonsillectomies per month (95% CI −0.97 to −0.34); p<0.0001). Codeine prescription fill rate continued to decrease but at a slower rate (−4.81 to −0.11 prescriptions per 1000 tonsillectomies per month; difference 4.69 (95% CI 3.60 to 5.79) prescriptions per 1000 tonsillectomies per month; p<0.0001). The index tonsillectomy inpatient admission rate decreased (1.12 to 0.23 admissions per 1000 tonsillectomies per month; difference −0.89 (95% CI −1.33 to −0.44) admissions per 1000 tonsillectomies per month; p<0.0001).ConclusionsThe payment and quality improvement programme was associated with several improvements in quality of care. These findings may inform jurisdictions planning health system interventions to improve quality of care for tonsillectomy and other paediatric procedures.

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

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.

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

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.

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

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.

scholarly journals 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

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.

Six Sigma Methodology and Postoperative Information Reporting: A Multidisciplinary Quality Improvement Study With Interrupted Time-Series Regression

2019 ◽  
Vol 76 (4) ◽  
pp. 1048-1067
Author(s):  
Aalap C. Shah ◽  
Andrew R. Herstein ◽  
Katherine T. Flynn-O'Brien ◽  
Daniel C. Oh ◽  
Anna H. Xue ◽  
...  
Keyword(s):  
Time Series ◽  
Quality Improvement ◽  
Six Sigma ◽  
Interrupted Time Series ◽  
Time Series Regression ◽  
Information Reporting ◽  
Six Sigma Methodology

Application of Interrupted Time Series Modelling to Prime Motor Spirit Distribution in Nigeria

2017 ◽  
Vol 7 (8) ◽  
pp. 46
Author(s):  
Ette Harrison Etuk ◽  
Imo Udo Moffat ◽  
Azubuike Samuel Agbam
Keyword(s):  
Time Series ◽  
Oil Industry ◽  
Interrupted Time Series ◽  
Intervention Model ◽  
Post Intervention ◽  
Abrupt Jump ◽  
Time Series Modelling ◽  
And Control ◽  
The Impact ◽  
Time Plot

An inspection of the time-plot of monthly Prime Motor Spirit (PMS) distribution in Nigeria from 2009 to 2015 reveals an abrupt jump in January 2013 with the series continuing at that level till 2015. Clearly the trend of the series was interrupted in January 2013 and it is believed that this perturbation was due to the deregulation of the downstream sector of the crude oil industry.  A t-test comparison of the pre- and the post-intervention means is highly significant (p < 0.0001) indicating the impact of the intervention. A model of the ARIMA family was to be fitted to the pre-intervention data which were observed to have a downward trend and be non-stationary. Differencing once rendered it stationary. An adequate ARIMA(2,1,0) model was fitted to the original pre-intervention series. Post-intervention forecasts were obtained on the basis of this model. These forecasts were subtracted from their respective post-intervention counterpart observations. These differences were modelled to obtain the transfer function of the intervention. The resultant intervention model closely fits the post-intervention data and may be used to explain and control the situation.

Sign in / Sign up

Export Citation Format

Share Document