A before and after study of the impact of Specialist Workers for Older People

2009 ◽  
Vol 15 (2) ◽  
pp. 335-340 ◽  
Author(s):  
K. Fletcher ◽  
J. Mant
Keyword(s):  
Older People ◽  
Before And After ◽  
The Impact ◽  
Before And After Study

scholarly journals Robust Inferences from a Before-and-After Study with Multiple Unaffected Control Groups

2013 ◽  
Vol 1 (2) ◽  
pp. 209-234 ◽  
Author(s):  
Pengyuan Wang ◽  
Mikhail Traskin ◽  
Dylan S. Small
Keyword(s):  
Sensitivity Analysis ◽  
Control Groups ◽  
Two Stage ◽  
Time Effects ◽  
Unaffected Control ◽  
Group Time ◽  
Before And After ◽  
Group Variation ◽  
The Impact ◽  
Before And After Study

AbstractThe before-and-after study with multiple unaffected control groups is widely applied to study treatment effects. The current methods usually assume that the control groups’ differences between the before and after periods, i.e. the group time effects, follow a normal distribution. However, there is usually no strong a priori evidence for the normality assumption, and there are not enough control groups to check the assumption. We propose to use a flexible skew-t distribution family to model group time effects, and consider a range of plausible skew-t distributions. Based on the skew-t distribution assumption, we propose a robust-t method to guarantee nominal significance level under a wide range of skew-t distributions, and hence make the inference robust to misspecification of the distribution of group time effects. We also propose a two-stage approach, which has lower power compared to the robust-t method, but provides an opportunity to conduct sensitivity analysis. Hence, the overall method of analysis is to use the robust-t method to test for the overall hypothesized range of shapes of group variation; if the test fails to reject, use the two-stage method to conduct a sensitivity analysis to see if there is a subset of group variation parameters for which we can be confident that there is a treatment effect. We apply the proposed methods to two datasets. One dataset is from the Current Population Survey (CPS) to study the impact of the Mariel Boatlift on Miami unemployment rates between 1979 and 1982.The other dataset contains the student enrollment and grade repeating data in West Germany in the 1960s with which we study the impact of the short school year in 1966–1967 on grade repeating rates.

AIRA, an Artificial Intelligence Realistic Assistant that will save your time, a before-and-after study during Pandemic (Preprint)

2021 ◽  
Author(s):  
Kaio Bin ◽  
Adler Araújo Ribeiro Melo ◽  
José Guilherme Franco Da Rocha ◽  
Renata Pivi De Almeida ◽  
Vilson Cobello Junior ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Electronic Health Record ◽  
Medical Care ◽  
Health Screening ◽  
Urgent Care ◽  
Health Record ◽  
Before And After ◽  
Electronic Health ◽  
The Impact ◽  
Before And After Study

BACKGROUND AIRA is an AI designed to reduce the time that doctors dedicate filling out EHR, winner of the first edition of MIT Hacking Medicine held in Brazil in 2020. As a proof of concept, AIRA was implemented in administrative process before its application in a medical process. OBJECTIVE The aim of the study is to determinate the impact of AIRA by eliminating the Medical Care Registration (MCR) on Electronic Health Record (EHR) by Administrative Officer. METHODS This is a comparative before-and-after study following the guidance “Evaluating digital health products” from Public Health England. An Artificial Intelligence named AIRA was created and implemented at CEAC (Employee Attention Center) from HCFMUSP. A total of 25,507 attendances were evaluated along 2020 for determinate AIRA´s impact. Total of MCR, time of health screening and time between the end of the screening and the beginning of medical care, were compared in the pre and post AIRA periods. RESULTS AIRA eliminated the need for Medical Care Registration by Administrative Officer in 92% (p<0.0001). The nurse´s time of health screening increased 16% (p<0.0001) during the implementation, and 13% (p<0.0001) until three months after the implementation, but reduced in 4% three months after implementation (p<0.0001). The mean and median total time to Medical Care after the nurse’ Screening was decreased in 30% (p<0.0001) and 41% (p<0.0001) respectively. CONCLUSIONS The implementation of AIRA reduced the time to medical care in an urgent care after the nurse´ screening, by eliminating non-value-added activity the Medical Care Registration on Electronic Health Record (EHR) by Administrative Officer.

scholarly journals 888. Improving outcomes with revised preoperative universal decolonization protocol

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S479-S479
Author(s):  
Silvia I Gnass
Keyword(s):  
Surgical Procedures ◽  
Baseline Period ◽  
Surgical Team ◽  
Team Members ◽  
Surgical Infection ◽  
Before And After ◽  
Trial Basis ◽  
The Impact ◽  
Before And After Study ◽  
Patient Infection

Abstract Background In order to improve outcomes, including reduced surgical infection rate and costs, a revised universal preoperative decolonization protocol was implemented on a trial basis. Methods In a 12 month before and after study at a public teaching hospital in southern California, an alcohol based nasal antiseptic was introduced in place of nasal povidone iodine (PVI) for all surgical patients pre-operatively, paired with chlorhexidine (CHG) bathing which was already in place. All surgical procedures were included, the most common being cholecystectomy, cesarean section and hip fracture. The alcohol nasal antiseptic was selected to replace the PVI nasal antiseptic based on efficacy, staff preference and cost. At the same time, surgical team members began self-application of the alcohol nasal antiseptic each day prior to surgical procedures. This was not mandatory and compliance was not tracked, though informal feedback and observation revealed most surgical team members were applying the nasal antiseptic prior to cases daily. Results In comparison to the 6 month baseline period where there were 27 SSI in 1188 procedures, during the 6 month study period there were 10 SSI in 1253 procedures, representing a 63% reduction (p=.0162) for all types of procedures. We have observed a reduction of 17 SSIs in 2019, compared to the previous year, during the 6 months period. That means a saving of $589,420 during the same period. Conclusion Preoperative universal decolonization with alcohol based nasal antiseptic in place of nasal PVI, paired with CHG bathing, was effective in reducing SSI rate and associated costs. Further study is needed to measure and assess the impact of surgical team member nasal decolonization on patient infection risk and rate. Disclosures All Authors: No reported disclosures

scholarly journals Telehealth to support referral management in a universal health system: a before-and-after study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sabrina Dalbosco Gadenz ◽  
Josué Basso ◽  
Patrícia Roberta Berithe Pedrosa de Oliviera ◽  
Stephan Sperling ◽  
Marcus Vinicius Dutra Zuanazzi ◽  
...  
Keyword(s):  
Linear Models ◽  
Patient Flow ◽  
Waiting Times ◽  
Median Number ◽  
Waiting Lists ◽  
Referral Management ◽  
Before And After ◽  
The Impact ◽  
Universal Health ◽  
Before And After Study

Abstract Background Management of patient flow within a healthcare network, allowing equitable and qualified access to healthcare, is a major challenge for universal health systems. Implementation of telehealth strategies to support referral management has been shown to increase primary care resolution and to promote coordination of care. The objective of this study was to assess the impact of telehealth strategies on waiting lists and waiting times for specialized care in Brazil. Methods Before-and-after study with measures obtained between January 2019 and February 2020. Baseline measurements of waiting lists were obtained immediately before the implementation of a remotely operated referral management system. Post-interventional measurements were obtained monthly, up to six months after the beginning of operation. Data was extracted from the database of the project. General linear models were applied to assess interaction of locality and time over number of cases on waiting lists and waiting times. Results At baseline, the median number of cases on waiting lists ranged from 2961 to 12,305 cases. Reductions of the number of cases on waiting lists after six months of operation were observed in all localities. The magnitude of the reduction ranged from 54.67 to 88.97 %. Interaction of time measurements was statistically significant from the second month onward. Median waiting times ranged from 159 to 241 days at baseline. After six months, there was a decrease of 100 and 114 waiting days in two localities, respectively, with reduction of waiting times only for high-risk cases in the third locality. Conclusions Adoption of telehealth strategies resulted in the reduction of number of cases on waiting lists. Results were consistent across localities, suggesting that telehealth interventions are viable in diverse settings.

scholarly journals Continuing education on child development for primary healthcare professionals: a prospective before-and-after study

2014 ◽  
Vol 132 (4) ◽  
pp. 211-218 ◽  
Author(s):  
Amira Consuêlo Melo Figueiras ◽  
Rosana Fiorini Puccini ◽  
Edina Mariko Koga Silva
Keyword(s):  
Child Development ◽  
Continuing Education ◽  
Education Program ◽  
Primary Healthcare ◽  
Healthcare Professionals ◽  
Before And After ◽  
The Impact ◽  
Children's Development ◽  
Before And After Study ◽  
Children’S Development

CONTEXT AND OBJECTIVE: Children's developmental disorders are often identified late by healthcare professionals working in primary care. The aim of this study was to assess the impact of a continuing education program on child development, on the knowledge and practices of these professionals.DESIGN AND SETTING: Prospective single-cohort study (before-and-after study), conducted in the city of Belém, Pará , Brazil.METHODS: Two hundred and twenty-one professionals working in primary healthcare (82.2%) participated in a continuing education program on child development and were assessed before and after implementation of the program through tests on their knowledge of child development, consisting of 19 questions for physicians and 14 for nurses, and questionnaires on their professional practices.RESULTS: One to three years after the program, the mean number of correct answers in the tests had increased from 11.5 to 14.3 among physicians in the Healthy Family Program (Programa Família Saudável, PFS); 13.0 to 14.3 among physicians in Municipal Health Units (Unidades Municipais de Saúde, UMS); 8.3 to 10.0 among PFS nurses; and 7.8 to 9.4 among UMS nurses. In interviews with mothers attended by these professionals before the program, only 21.7% reported that they were asked about their children's development, 24.7% reported that the professional asked about or observed their children's development and 11.1% received advice on how to stimulate them. After the program, these percentages increased to 34.5%, 54.2% and 30.3%, respectively.CONCLUSIONS: Professionals who participated in the program showed improved performance regarding child development knowledge and practices.

scholarly journals The Impact of Technology on Prescribing Errors in Pediatric Intensive Care: A Before and After Study

2020 ◽  
Vol 11 (02) ◽  
pp. 323-335 ◽  
Author(s):  
Moninne M. Howlett ◽  
Eileen Butler ◽  
Karen M. Lavelle ◽  
Brian J. Cleary ◽  
Cormac V. Breatnach
Keyword(s):  
Intensive Care ◽  
New Technology ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Error Rates ◽  
Electronic Prescribing ◽  
Prescribing Errors ◽  
Before And After ◽  
The Impact ◽  
Before And After Study

Abstract Background Increased use of health information technology (HIT) has been advocated as a medication error reduction strategy. Evidence of its benefits in the pediatric setting remains limited. In 2012, electronic prescribing (ICCA, Philips, United Kingdom) and standard concentration infusions (SCIs)—facilitated by smart-pump technology—were introduced into the pediatric intensive care unit (PICU) of an Irish tertiary-care pediatric hospital. Objective The aim of this study is to assess the impact of the new technology on the rate and severity of PICU prescribing errors and identify technology-generated errors. Methods A retrospective, before and after study design, was employed. Medication orders were reviewed over 24 weeks distributed across four time periods: preimplementation (Epoch 1); postimplementation of SCIs (Epoch 2); immediate postimplementation of electronic prescribing (Epoch 3); and 1 year postimplementation (Epoch 4). Only orders reviewed by a clinical pharmacist were included. Prespecified definitions, multidisciplinary consensus and validated grading methods were utilized. Results A total of 3,356 medication orders for 288 patients were included. Overall error rates were similar in Epoch 1 and 4 (10.2 vs. 9.8%; p = 0.8), but error types differed (p < 0.001). Incomplete and wrong unit errors were eradicated; duplicate orders increased. Dosing errors remained most common. A total of 27% of postimplementation errors were technology-generated. Implementation of SCIs alone was associated with significant reductions in infusion-related prescribing errors (29.0% [Epoch 1] to 14.6% [Epoch 2]; p < 0.001). Further reductions (8.4% [Epoch 4]) were identified after implementation of electronically generated infusion orders. Non-infusion error severity was unchanged (p = 0.13); fewer infusion errors reached the patient (p < 0.01). No errors causing harm were identified. Conclusion The limitations of electronic prescribing in reducing overall prescribing errors in PICU have been demonstrated. The replacement of weight-based infusions with SCIs was associated with significant reductions in infusion prescribing errors. Technology-generated errors were common, highlighting the need for on-going research on HIT implementation in pediatric settings.

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