525. The Impact of Switching to Molecular Testing on Clostridium difficile Infection Rates: Large-Scale Assessment Using an Interrupted Time Series Poisson Regression Approach

Abstract Background Interrupted time series analysis is increasingly used to evaluate the impact of large-scale health interventions. While segmented regression is a common approach, it is not always adequate, especially in the presence of seasonality and autocorrelation. An Autoregressive Integrated Moving Average (ARIMA) model is an alternative method that can accommodate these issues. Methods We describe the underlying theory behind ARIMA models and how they can be used to evaluate population-level interventions, such as the introduction of health policies. We discuss how to select the shape of the impact, the model selection process, transfer functions, checking model fit, and interpretation of findings. We also provide R and SAS code to replicate our results. Results We illustrate ARIMA modelling using the example of a policy intervention to reduce inappropriate prescribing. In January 2014, the Australian government eliminated prescription refills for the 25 mg tablet strength of quetiapine, an antipsychotic, to deter its prescribing for non-approved indications. We examine the impact of this policy intervention on dispensing of quetiapine using dispensing claims data. Conclusions ARIMA modelling is a useful tool to evaluate the impact of large-scale interventions when other approaches are not suitable, as it can account for underlying trends, autocorrelation and seasonality and allows for flexible modelling of different types of impacts.

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Impact of Discontinuing Contact Precautions for Methicillin-ResistantStaphylococcus aureusand Vancomycin-ResistantEnterococcus: An Interrupted Time Series Analysis

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.57 ◽

2018 ◽

Vol 39 (6) ◽

pp. 676-682 ◽

Cited By ~ 20

Author(s):

Gonzalo Bearman ◽

Salma Abbas ◽

Nadia Masroor ◽

Kakotan Sanogo ◽

Ginger Vanhoozer ◽

...

Keyword(s):

Time Series ◽

Infection Prevention ◽

Urinary Catheter ◽

Medical Center ◽

Academic Medical Center ◽

Interrupted Time Series ◽

Infection Rates ◽

Interrupted Time Series Analysis ◽

Contact Precautions ◽

The Impact

OBJECTIVETo investigate the impact of discontinuing contact precautions among patients infected or colonized with methicillin-resistantStaphylococcus aureus(MRSA) or vancomycin-resistantEnterococcus(VRE) on rates of healthcare-associated infection (HAI). DESIGN. Single-center, quasi-experimental study conducted between 2011 and 2016.METHODSWe employed an interrupted time series design to evaluate the impact of 7 horizontal infection prevention interventions across intensive care units (ICUs) and hospital wards at an 865-bed urban, academic medical center. These interventions included (1) implementation of a urinary catheter bundle in January 2011, (2) chlorhexidine gluconate (CHG) perineal care outside ICUs in June 2011, (3) hospital-wide CHG bathing outside of ICUs in March 2012, (4) discontinuation of contact precautions in April 2013 for MRSA and VRE, (5) assessments and feedback with bare below the elbows (BBE) and contact precautions in August 2014, (6) implementation of an ultraviolet-C disinfection robot in March 2015, and (7) 72-hour automatic urinary catheter discontinuation orders in March 2016. Segmented regression modeling was performed to assess the changes in the infection rates attributable to the interventions.RESULTSThe rate of HAI declined throughout the study period. Infection rates for MRSA and VRE decreased by 1.31 (P=.76) and 6.25 (P=.21) per 100,000 patient days, respectively, and the infection rate decreased by 2.44 per 10,000 patient days (P=.23) for device-associated HAI following discontinuation of contact precautions.CONCLUSIONThe discontinuation of contact precautions for patients infected or colonized with MRSA or VRE, when combined with horizontal infection prevention measures was not associated with an increased incidence of MRSA and VRE device-associated infections. This approach may represent a safe and cost-effective strategy for managing these patients.Infect Control Hosp Epidemiol2018;39:676–682

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Faculty Opinions recommendation of Evaluation of the national Cleanyourhands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717963447.793464518 ◽

2012 ◽

Author(s):

Chris Robertson

Keyword(s):

Staphylococcus Aureus ◽

Time Series ◽

Clostridium Difficile ◽

Hand Hygiene ◽

Clostridium Difficile Infection ◽

Interrupted Time Series ◽

England And Wales ◽

Time Series Study ◽

Series Study

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The Impact of Lockdown in England on Daily Confirmed Cases of COVID-19 and Related Deaths Compared to Sweden: A Comparative Interrupted Time Series Analysis

SSRN Electronic Journal ◽

10.2139/ssrn.3629457 ◽

2020 ◽

Author(s):

Moaath Mustafa Ali ◽

Yazan Samhouri ◽

Marwa Sabha ◽

Lynna Alnimer

Keyword(s):

Time Series ◽

Time Series Analysis ◽

Interrupted Time Series ◽

Interrupted Time Series Analysis ◽

Series Analysis ◽

The Impact

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Correction to: Measuring the impact of the Afordable Care Act Medicaid expansion on access to primary care using an interrupted time series approach

Health Research Policy and Systems ◽

10.1186/s12961-021-00740-y ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Elizabeth A. Brown ◽

Brandi M. White ◽

Walter J. Jones ◽

Mulugeta Gebregziabher ◽

Kit N. Simpson

Keyword(s):

Primary Care ◽

Time Series ◽

Interrupted Time Series ◽

Medicaid Expansion ◽

Time Series Approach ◽

Access To Primary Care ◽

The Impact

An amendment to this paper has been published and can be accessed via the original article.

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

BMC Health Services Research ◽

10.1186/s12913-021-06070-7 ◽

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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Recession and risk of suicide in Denmark during the 2009 global financial crisis: an ecological register-based study

Scandinavian Journal of Public Health ◽

10.1177/14034948211013270 ◽

2021 ◽

pp. 140349482110132

Author(s):

Agnieszka Konieczna ◽

Sarah Grube Jakobsen ◽

Christina Petrea Larsen ◽

Erik Christiansen

Keyword(s):

Time Series ◽

Financial Crisis ◽

Time Series Analysis ◽

Suicide Rate ◽

Global Financial Crisis ◽

Interrupted Time Series ◽

Interrupted Time Series Analysis ◽

Series Analysis ◽

Prevention Programmes ◽

The Impact

Aim: The aim of this study is to analyse the potential impact from the financial crisis (onset in 2009) on suicide rates in Denmark. The hypothesis is that the global financial crisis raised unemployment which leads to raising the suicide rate in Denmark and that the impact is most prominent in men. Method: This study used an ecological study design, including register data from 2001 until 2016 on unemployment, suicide, gender and calendar time which was analysed using Poisson regression models and interrupted time series analysis. Results: The correlation between unemployment and suicide rates was positive in the period and statistically significant for all, but at a moderate level. A dichotomised version of time (calendar year) showed a significant reduction in the suicide rate for women (incidence rate ratio 0.87, P=0.002). Interrupted time series analysis showed a significant decreasing trend for the overall suicide rate and for men in the pre-recession period, which in both cases stagnated after the onset of recession in 2009. The difference between the genders’ suicide rate changed significantly at the onset of recession, as the rate for men increased and the rate for women decreased. Discussion: The Danish social welfare model might have prevented social disintegration and suicide among unemployed, and suicide prevention programmes might have prevented deaths among unemployed and mentally ill individuals. Conclusions: We found some indications for gender-specific differences from the impact of the financial crises on the suicide rate. We recommend that men should be specifically targeted for appropriate prevention programmes during periods of economic downturn.

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