scholarly journals Impacts of bariatric surgery on costs and health outcomes of patients in Brazil: Interrupted time series analysis of multi-panel data

2020 ◽  
Author(s):  
Jose Antonio Orellana Turri ◽  
Edmund Chada Baracat ◽  
Jose Maria Soares ◽  
Lionai Lima dos Santos ◽  
Marco Aurelio Santo ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Health Care ◽  
Time Series ◽  
Health Status ◽  
Health Outcomes ◽  
Severe Obesity ◽  
Interrupted Time Series ◽  
Direct Costs ◽  
Interrupted Time Series Analysis ◽  
Post Intervention

Obesity is one of the most important public health problems worldwide, presenting significant socioeconomic impacts in health systems. Considering the rising costs of health care and the escalating burden of obesity in diverse countries, there has been increasing trends in examination of cost-effectiveness of health interventions towards prevention and treatment of obesity and its effects on comorbidities. Bariatric surgery has been considered an effective intervention for reducing moderate to severe obesity and improvement of obesity-related morbidities. Methodology: Interrupted Time-Series Analysis (ITSA) on costs and health outcomes from retrospective cohort of 114 patients who had bariatric surgery at the Hospital of Clinics from the University of Sao Paulo. Medical records encompassing complete data on anthropometric, hemodynamic and biochemical parameters, utilization of resources and costs for health care procedures and regular assessments of patients health status associated with bariatric surgery at individual level were included in the study. Data on utilization of resources during outpatient and inpatient health care were used for estimation of patients direct costs referring to bariatric surgery, and 6-month pre- and post-intervention periods, adopting health system perspective in micro-costing approach. Results: Mean direct costs of hospitalization (-US$2,762.22; -23.2%), image exams (-US$7.53; -0.8%) and medication (-US$175.37; -25,7%) presented decrease after bariatric surgery, and total direct cost (US$1,375.37; +138%), consultations (US$0.42; +2.4%) and laboratory exams (US$68.96; +63.4%) had increase. Reduction in weight, BMI, LDL, triglycerides, insulin, glucose-linked hemoglobin, and glucose showed improvements in patients health status after bariatric surgery. Cholesterol, VLDL, and HDL presenting increase after surgery. Conclusion: Bariatric surgery represents an effective intervention for treatment of moderate to severe obesity with extensive benefits regarding health promotion and reduction of burden of disease. Trends in direct costs and multiple health outcomes showed post-intervention improvements in patients health status and reduction of health care needs of individuals.

scholarly journals Impacts of bariatric surgery in health outcomes and health care costs in Brazil: Interrupted time series analysis of multi-panel data

2021 ◽  
Author(s):  
Jose Antonio Orellana Turri ◽  
Nana Kwame Anokye ◽  
Lionai Lima dos Santos ◽  
José Maria Soares Júnior ◽  
Edmund Chada Baraccat ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Health Care ◽  
Time Series ◽  
Health Status ◽  
Health Outcomes ◽  
Health Care Costs ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Care Costs ◽  
Multiple Health

Abstract Background: The increasing burden of obesity generates significant socioeconomic impacts for individuals, populations, and national health systems worldwide. The literature on impacts and cost-effectiveness of obesity-related interventions for prevention and treatment of moderate to severe obesity indicate that bariatric surgery presents high costs associated with high effectiveness in improving health status referring to certain outcomes; however, there is a lack of robust evidence at an individual-level estimation of its impacts on multiple health outcomes related to obesity comorbidities.Methods: The study encompasses a single-centre retrospective longitudinal analysis of patient-level data using micro-costing technique to estimate direct health care costs with cost-effectiveness for multiple health outcomes pre-and post-bariatric surgery. Data from 114 patients who had bariatric surgery at the Hospital of Clinics of the University of Sao Paulo during 2018 were investigated through interrupted time-series analysis with generalised estimating equations and marginal effects, including information on patients' characteristics, lifestyle, anthropometric measures, hemodynamic measures, biochemical exams, and utilisation of health care resources during screening (180 days before) and follow-up (180 days after) of bariatric surgery.Results: The preliminary statistical analysis showed that health outcomes presented improvement, except cholesterol and VLDL, and overall direct health care costs increased after the intervention. However, interrupted time series analysis showed that the rise in health care costs is attributable to the high cost of bariatric surgery, followed by a statistically significant decrease in post-intervention health care costs. Changes in health outcomes were also statistically significant in general, except in cholesterol and LDL, leading to significant improvements in patients' health status after the intervention.Conclusions: Trends multiple health outcomes showed statistically significant improvements in patients' health status post-intervention compared to trends pre-intervention, resulting in reduced direct health care costs and the burden of obesity.

scholarly journals Impacts of bariatric surgery in health outcomes and health care costs in Brazil: Interrupted time series analysis of multi-panel data

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
José Antonio Orellana Turri ◽  
Nana Kwame Anokye ◽  
Lionai Lima dos Santos ◽  
José Maria Soares Júnior ◽  
Edmund Chada Baracat ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Health Care ◽  
Time Series ◽  
Health Status ◽  
Health Outcomes ◽  
Health Care Costs ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Care Costs ◽  
Multiple Health

Abstract Background The increasing burden of obesity generates significant socioeconomic impacts for individuals, populations, and national health systems worldwide. The literature on impacts and cost-effectiveness of obesity-related interventions for prevention and treatment of moderate to severe obesity indicate that bariatric surgery presents high costs associated with high effectiveness in improving health status referring to certain outcomes; however, there is a lack of robust evidence at an individual-level estimation of its impacts on multiple health outcomes related to obesity comorbidities. Methods The study encompasses a single-centre retrospective longitudinal analysis of patient-level data using micro-costing technique to estimate direct health care costs with cost-effectiveness for multiple health outcomes pre-and post-bariatric surgery. Data from 114 patients who had bariatric surgery at the Hospital of Clinics of the University of Sao Paulo during 2018 were investigated through interrupted time-series analysis with generalised estimating equations and marginal effects, including information on patients' characteristics, lifestyle, anthropometric measures, hemodynamic measures, biochemical exams, and utilisation of health care resources during screening (180 days before) and follow-up (180 days after) of bariatric surgery. Results The preliminary statistical analysis showed that health outcomes presented improvement, except cholesterol and VLDL, and overall direct health care costs increased after the intervention. However, interrupted time series analysis showed that the rise in health care costs is attributable to the high cost of bariatric surgery, followed by a statistically significant decrease in post-intervention health care costs. Changes in health outcomes were also statistically significant in general, except in cholesterol and LDL, leading to significant improvements in patients' health status after the intervention. Conclusions Trends multiple health outcomes showed statistically significant improvements in patients' health status post-intervention compared to trends pre-intervention, resulting in reduced direct health care costs and the burden of obesity.

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.

Does rural health system reform aimed at improving access to primary health care affect hospitalization rates? An interrupted time series analysis of national policy reforms in Iran

2019 ◽  
Vol 24 (2) ◽  
pp. 73-80 ◽  
Author(s):  
Arash Rashidian ◽  
Sedigheh Salavati ◽  
Hanan Hajimahmoodi ◽  
Mehrnaz Kheirandish
Keyword(s):  
Health Care ◽  
Time Series ◽  
Primary Health Care ◽  
Time Series Analysis ◽  
Rural Health ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Hospitalization Rates ◽  
Primary Health

Objectives To evaluate the effects of rural health insurance and family physician reforms on hospitalization rates in Iran. Methods An interrupted time series analysis of national monthly hospitalization rates in Iran (2003–2014), starting from two years before the intervention. Segmented regression analysis was used to assess the effects of the reforms on hospitalization rates. Results The analyses showed that hospitalization rates increased one year after the initiation of the reforms: 1.55 (95% CI: 1.24–1.86) additional hospitalizations per 1000 rural inhabitants per month (‘immediate effect’). This increase was followed by a further gradual increase of 0.034 per 1000 inhabitants per month (95% CI: 0.02–0.04). The gradual monthly increase continued for two years after the reforms. The higher hospitalization rates were maintained in the following years. We observed a significant increase in hospitalization rates at a national level in rural areas that continued for over 10 years after the policy implementation. Conclusion Primary health care reforms are often proposed for their efficiency outcomes (i.e. reduction in costs and use of hospitals) as well as their impact on improving health outcomes. We demonstrated that in populations with unmet needs, such reforms are likely to substantially increase hospitalization rates. This is an important consideration for successful design and implementation of interventions aimed at achieving universal health coverage in low- and middle-income countries.

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 A Smartphone App for Engaging Patients With Catheter-Associated Urinary Tract Infections: Protocol for an Interrupted Time-Series Analysis

10.2196/28314 ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. e28314
Author(s):  
Robbert Gerard Bentvelsen ◽  
Karin Ellen Veldkamp ◽  
Niels H Chavannes
Keyword(s):  
Health Care ◽  
Time Series ◽  
Time Series Analysis ◽  
Health Care Services ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Inappropriate Use ◽  
Series Analysis ◽  
Care Services ◽  
Tract Infections

Background Catheter-associated urinary tract infections (CAUTIs) are the main cause of health care–associated infections, and they increase the disease burden, antibiotic usage, and hospital stay. Inappropriate placement and unnecessarily prolonged usage of a catheter lead to an elevated and preventable risk of infection. The smartphone app Participatient has been developed to involve hospitalized patients in communication and decision-making related to catheter use and to control unnecessary (long-term) catheter use to prevent CAUTIs. Sustained behavioral changes for infection prevention can be promoted by empowering patients through Participatient. Objective The primary aim of our multicenter prospective interrupted time-series analysis is to reduce inappropriate catheter usage by 15%. We will evaluate the efficacy of Participatient in this quality improvement study in clinical wards. Our secondary endpoints are to reduce CAUTIs and to increase patient satisfaction, involvement, and trust with health care services. Methods We will conduct a multicenter interrupted time-series analysis—a strong study design when randomization is not feasible—consisting of a pre- and postintervention point-prevalence survey distributed among participating wards to investigate the efficacy of Participatient in reducing the inappropriate usage of catheters. After customizing Participatient to the wards’ requirements, it will be implemented with a catheter indication checklist among clinical wards in 4 large hospitals in the Netherlands. We will collect clinical data every 2 weeks for 6 months in the pre- and postintervention periods. Simultaneously, we will assess the impact of Participatient on patient satisfaction with health care services and providers and the patients’ perceived involvement in health care through questionnaires, and the barriers and facilitators of eHealth implementation through interviews with health care workers. Results To reduce the inappropriate use of approximately 40% of catheters (currently in use) by 15%, we aim to collect 9-12 data points from 70-100 patients per survey date per hospital. Thereafter, we will conduct an interrupted time-series analysis and present the difference between the unadjusted and adjusted rate ratios with a corresponding 95% CI. Differences will be considered significant when P<.05. Conclusions Our protocol may help reduce the inappropriate use of catheters and subsequent CAUTIs. By sharing reliable information and daily checklists with hospitalized patients via an app, we aim to provide them a tool to be involved in health care–related decision-making and to increase the quality of care. Trial Registration Netherlands Trial Register NL7178; https://www.trialregister.nl/trial/7178 International Registered Report Identifier (IRRID) DERR1-10.2196/28314

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.

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