Measuring the impact of step down intermediate care on delayed discharge: an interrupted time series analysis

2019 ◽  
Vol 73 (7) ◽  
pp. 674-679 ◽  
Author(s):  
Kate A Levin ◽  
Emilia Crighton
Keyword(s):  
Moving Average ◽  
Interrupted Time Series ◽  
Relative Reduction ◽  
Intermediate Care ◽  
Interrupted Time Series Analysis ◽  
Level Change ◽  
Before And After ◽  
Step Down ◽  
The Impact ◽  
Over Time

BackgroundIntermediate care (IC) acts as a bridging service between hospital and home, for those deemed medically fit for discharge but who are delayed in hospital. The aim of this study was to measure the effect of IC and a 72-hour discharge target on days delayed.MethodsRate of days delayed per 1000 population aged 75 years+ in Glasgow City was compared before and after onset of IC with a 6-month phase-in period, using segmented linear regression. Inverclyde and West Dunbartonshire (IWD) was a control. Autoregressive and moving average terms were included in the model, as well as a Fourier term to adjust for seasonality.ResultsPrior to IC, rate of days delayed increased in both Glasgow City and the rest of Scotland. There was a large reduction in rate of days delayed in Glasgow during the phase-in period, greater than the rest of Scotland but comparable with that observed in IWD, with subsequent increases thereafter. Adjusting for changes in IWD, the impact of IC and the discharge target in Glasgow City was a level change of −15.20 (95% CI −17.52 to –12.88) and a trend change of −0.29 (95% CI −0.55 to –0.02). This is equivalent to a predicted reduction due to IC of −16.04 days delayed per 1000 population per month, in June 2016, and a relative reduction of 35%.ConclusionIC and the 72-hour discharge target were associated with a reduction in days delayed. Rate of days delayed continued to increase over time, although at a slower rate than if IC had not been implemented.

scholarly journals Impact of the Govan SHIP case management project on emergency hospital admission and GP interactions

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
K Levin ◽  
E Crighton
Keyword(s):  
Moving Average ◽  
Multidisciplinary Teams ◽  
Relative Reduction ◽  
Post Intervention ◽  
Level Change ◽  
Before And After ◽  
Patients At Risk ◽  
Significant Change ◽  
The Impact ◽  
Over Time

Abstract Background The Social and Health Integration Partnership (SHIP) project was implemented in Govan, a deprived area in Glasgow in 2015. This involved multidisciplinary teams, including GPs and social workers, identifying and supporting vulnerable patients at risk of attending A&E and GP surgeries. This study measures the impact of SHIP on A&E presentations and GP interactions. Methods Rate of A&E presentations per 1000 population in 3 participating GP practices in Govan was compared before and after onset of the service, using segmented linear regression with 9-month pre- and 36-month post- intervention periods. Rates of GP interactions were also compared, using 21-month pre- and 36-month post- intervention periods. Rates of A&E presentations and GP interactions for practice population in Drumchapel- an area with similar rates of deprivation - were used as a control. Models included autoregressive and moving average terms, and a fourier term to adjust for seasonality. Results Govan had a lower rate of A&E presentations than Drumchapel. A&E presentations did not change significantly over time prior to SHIP in either area. At April 2015, SHIP onset, a level change of -4.34 (-7.44, -1.24) A&E presentations per 1000 was observed in both areas, however , onset of SHIP was not associated with a reduction in level or trend in A&E presentations. Rate of interactions with GP was greater in Govan than Drumchapel prior to SHIP, increasing over time in both areas. After SHIP implementation there was a significant level change of 33.78 (19.57, 47.99) per 1000 across both areas. GP interactions in Govan however saw a further reduction of -1.48 (-2.87, -0.09) per 1000 per month. This is equivalent to SHIP being associated with an absolute reduction of 37 GP interactions per thousand and a relative reduction of 7.2% by March 2018. Conclusions The Govan SHIP initiative was associated with no significant change in A&E presentations and some small reduction in GP interactions. Key messages The Govan SHIP initiative was associated with no significant change in A&E presentations and a small significant reduction in GP interactions. A cost effectiveness analysis of the project is recommended, given the relatively small benefits observed.

scholarly journals Association of flavoured cigar regulations with wholesale tobacco volumes in Canada: an interrupted time series analysis

2018 ◽  
Vol 28 (4) ◽  
pp. 457-461 ◽  
Author(s):  
Michael O Chaiton ◽  
Robert Schwartz ◽  
Gabrielle Tremblay ◽  
Robert Nugent
Keyword(s):  
Time Series ◽  
Sensitivity Analysis ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Level Change ◽  
Series Analysis ◽  
Tobacco Sales ◽  
Health Canada ◽  
Over Time

IntroductionThis study examines the association of Federal Canadian regulations passed in 2009 addressing flavours (excluding menthol) in small cigars with changes in cigar sales.MethodsQuarterly wholesale unit data as reported to Health Canada from 2001 through 2016 were analysed using interrupted time series analysis. Changes in sales of cigars with and without flavour descriptors were estimated. Analyses were seasonally adjusted. Changes in the flavour types were assessed over time.ResultsThe Federal flavour regulations were associated with a reduction in the sales of flavoured cigars by 59 million units (95% CI −86.0 to −32.4). Increases in sales of cigars with descriptors other than flavours (eg, colour or other ambiguous terms) were observed (9.6 million increase (95% CI −1.3 to 20.5), but the overall level (decline of 49.6 million units (95% CI −73.5 to −25.8) and trend of sales of cigars (6.9 million units per quarter (95% CI −8.1 to −5.7)) declined following the ban. Sensitivity analysis showed that there was no substantial difference in effect over time comparing Ontario and British Columbia, suggesting that other provincial tobacco control legislation was not associated with the changes in levels. Analyses suggested that the level change was sensitive to the specification of the date.ConclusionThis study demonstrates that flavour regulations have the potential to substantially impact tobacco sales. However, exemptions for certain flavours and product types may have reduced the effectiveness of the ban, indicating the need for comprehensive, well-designed regulations.

Vancomycin Use: Room for Improvement Among Hospitalized Children

2016 ◽  
Vol 30 (3) ◽  
pp. 296-299 ◽  
Author(s):  
Jessica Gillon ◽  
Meng Xu ◽  
James Slaughter ◽  
M. Cecilia Di Pentima
Keyword(s):  
Real Time ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
Hospitalized Children ◽  
Interrupted Time Series Analysis ◽  
Prospective Audit ◽  
Children's Hospitals ◽  
Children’S Hospitals ◽  
Before And After ◽  
The Impact

Introduction: The use of vancomycin is common among hospitalized children. We sought to evaluate the impact of prospective audit with real-time feedback on vancomycin use and pharmacy costs. Methods: Vancomycin use was evaluated at Monroe Carell Jr Children’s Hospital at Vanderbilt (MCJCHV) before and after the implementation of prospective audit with intervention and feedback to providers in 2012. Antibiotic use was compared to academic children’s hospitals with established antimicrobial stewardship programs (ASPs). Two similar pediatric academic institutions without an ASP were used as nonintervention controls. Analysis of monthly days of antibiotic therapy (DoT) per 1000 patient-days was performed by interrupted time series analysis. Results: Monthly vancomycin use decreased from 114 DoTs/1000 patient-days to 89 DoTs/1000 patient-days ( P < .0001). We did not find significant differences in the slope of change in vancomycin use between MCJCHV and institutions with ASPs either before or after the intervention ( P = .86 and P = .71, respectively). When compared to children’s hospitals without ASPs, the use of vancomycin was significantly lower at MCJCHV ( P < .001). Conclusion: The use of vancomycin at academic children’s hospitals with an ASP is declining. In our experience, prospective audit with real-time intervention and feedback to providers significantly reduced the use and costs associated with vancomycin.

scholarly journals Transformation of the Tanzania Medical Store Department through Global Fund support: lessons learned from the field

2020 ◽  
Author(s):  
Patrick Githendu ◽  
Linden Morrison ◽  
Rosemary Silaa ◽  
Sai Pothapregada ◽  
Sarah Asiimwe ◽  
...  
Keyword(s):  
Global Fund ◽  
Interrupted Time Series ◽  
Lessons Learned ◽  
Interrupted Time Series Analysis ◽  
Monthly Basis ◽  
Quantitative And Qualitative Research ◽  
Before And After ◽  
Multi Stakeholder ◽  
Health Commodities ◽  
The Impact

AbstractBackgroundThe Tanzania government sought support from The Global Fund to Fight AIDs, Tuberculosis and Malaria (Global Fund) to reform its Medical Stores Department (MSD), with the aim of improving performance. Our study aimed to assess the impact of the reforms and document the lessons learned.MethodsWe applied quantitative and qualitative research methods to assess the impact of the reforms. The quantitative part entailed a review of operational and financial data covering the period before and after the implementation of the reforms. We applied interrupted time series analysis to determine the change in average availability of essential health commodities at health zones. Qualitative data was collected through 41 key informant interviews. Participants were identified through stakeholder mapping, purposive and snowballing sampling techniques, and responses were analyzed through thematic content analysis.ResultsAvailability of essential health commodities increased significantly by 12.6% (95%CI, 9.6-15.6), after the reforms and continued to increase on a monthly basis by 0.2% (95%CI, 0.0-0.3) relative to the preintervention trend. Sales increased by 56.6% while the cost of goods sold increased by 88.6% between 2014/15 and 2017/18. Surplus income increased by 56.4% between 2014/15 and 2017/18, with reductions in rent and fuel expenditure. There was consensus among participants that the reforms, were instrumental in improving performance of MSD.ConclusionMany positive results were realized through the reforms at MSD. However, despite the progress, there were risks such as the increasing government receivable that could jeopardize the gains. Multi-stakeholder efforts are necessary, to sustain the progress and expand public health.

scholarly journals Assessment of the Impact of COVID-19 pandemic on population level interest in Skincare: Evidence from a google trends-based Infodemiology study

2020 ◽  
Author(s):  
Hasan Symum ◽  
Md. F. Islam ◽  
Habsa K. Hiya ◽  
Kh M. Ali Sagor
Keyword(s):  
Time Series ◽  
Moving Average ◽  
Arima Model ◽  
Population Level ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Search Volume ◽  
Quasi Experimental ◽  
Relative Search Volume ◽  
The Impact

AbstractBackgroundCOVID-19 pandemic created an unprecedented disruption of daily life including the pattern of skin related treatments in healthcare settings by issuing stay-at-home orders and newly coronaphobia around the world.ObjectiveThis study aimed to evaluate whether there are any significant changes in population interest for skincare during the COVID-19 pandemic.MethodsFor the skincare, weekly RSV data were extracted for worldwide and 23 counties between August 1, 2016, and August 31, 2020. Interrupted time-series analysis was conducted as the quasi-experimental approach to evaluate the longitudinal effects of COVID-19 skincare related search queries. For each country, autoregressive integrated moving average (ARIMA) model relative search volume (RSV) time series and then testing multiple periods simultaneously to examine the magnitude of the interruption. Multivariate linear regression was used to estimate the correlation between countries’ relative changes in RSV with COVID-19 confirmed cases/ per 10000 patients and lockdown measures.ResultsOut of 23 included countries in our study, 17 showed significantly increased (p<0.01) RSVs during the lockdown period compared with the ARIMA forecasted data. The highest percentage of increments occurs in May and June 2020 in most countries. There was also a significant correlation between lockdown measures and the number of COVID-19 cases with relatives changes in population interests for skincare.ConclusionUnderstanding the trend and changes in skincare public interest during COVID-19 may assist health authorities to promote accessible educational information and preventive initiatives regarding skin problems.

scholarly journals The impact of an electronic medical record nudge on reducing testing for hospital-onset Clostridioides difficile infection

2020 ◽  
Vol 41 (4) ◽  
pp. 411-417 ◽  
Author(s):  
Jessica R. Howard-Anderson ◽  
Mary Elizabeth Sexton ◽  
Chad Robichaux ◽  
Zanthia Wiley ◽  
Jay B. Varkey ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Level Change ◽  
Order Rate ◽  
Clostridioides Difficile ◽  
Stool Softener ◽  
Clostridioides Difficile Infection ◽  
The Impact

AbstractObjective:To determine the effect of an electronic medical record (EMR) nudge at reducing total and inappropriate orders testing for hospital-onset Clostridioides difficile infection (HO-CDI).Design:An interrupted time series analysis of HO-CDI orders 2 years before and 2 years after the implementation of an EMR intervention designed to reduce inappropriate HO-CDI testing. Orders for C. difficile testing were considered inappropriate if the patient had received a laxative or stool softener in the previous 24 hours.Setting:Four hospitals in an academic healthcare network.Patients:All patients with a C. difficile order after hospital day 3.Intervention:Orders for C. difficile testing in patients administered a laxative or stool softener in <24 hours triggered an EMR alert defaulting to cancellation of the order (“nudge”).Results:Of the 17,694 HO-CDI orders, 7% were inappropriate (8% prentervention vs 6% postintervention; P < .001). Monthly HO-CDI orders decreased by 21% postintervention (level-change rate ratio [RR], 0.79; 95% confidence interval [CI], 0.73–0.86), and the rate continued to decrease (postintervention trend change RR, 0.99; 95% CI, 0.98–1.00). The intervention was not associated with a level change in inappropriate HO-CDI orders (RR, 0.80; 95% CI, 0.61–1.05), but the postintervention inappropriate order rate decreased over time (RR, 0.95; 95% CI, 0.93–0.97).Conclusion:An EMR nudge to minimize inappropriate ordering for C. difficile was effective at reducing HO-CDI orders, and likely contributed to decreasing the inappropriate HO-CDI order rate after the intervention.

scholarly journals Assessing the impact of retraction on the citation of randomized controlled trial reports: an interrupted time-series analysis

2018 ◽  
Vol 24 (1) ◽  
pp. 44-51 ◽  
Author(s):  
Andrew Mott ◽  
Caroline Fairhurst ◽  
David Torgerson
Keyword(s):  
Time Series ◽  
Randomized Controlled Trial ◽  
Randomized Controlled Trials ◽  
Controlled Trial ◽  
Interrupted Time Series ◽  
Controlled Trials ◽  
Interrupted Time Series Analysis ◽  
Randomized Controlled ◽  
Before And After ◽  
The Impact

Objectives To assess the impact of retraction on the citation of randomized controlled trials. Methods We used an interrupted time-series with matched controls. PubMed, CINHAL, Google and the Retraction Watch Database were searched. We identified retracted publications reporting the results of randomized controlled trials involving human participants with two years of available data before and after retraction. We obtained monthly citation counts across all articles for the 24 months before and after retraction, from Web of Science. We used a Poisson segmented regression to detect changes in the level and trend of citation following retraction. We also undertook a matched control analysis of unretracted randomized controlled trials and a sensitivity analysis to account for cases of large-scale, well-advertised fraud. Results We identified 387 retracted randomized controlled trial reports, of which 218 (56.3%) were included in the interrupted time-series analysis. A reduction of 22.9% (95% CI 4.0% to 38.2%, p = 0.02) was observed in the number of citations in the month after retraction, and a further reduction of 1.9% (95% CI 0.4% to 3.5%, p = 0.02) per month in the following 24 months, relative to the expected trend. There was no evidence of a statistically significant reduction among the matched controls. Authors with a large number of retractions saw a 48.2% reduction at the time of retraction (95% CI 17.7% to 67.3%, p = 0.01). Other cases had a more gradual reduction with no change at the time of retraction and a 1.8% reduction per month in the following 24 months (95% CI 0.2% to 3.4%, p = 0.03). Conclusions Retractions of randomized controlled trial reports can be effective in reducing citations. Other factors, such as the scale of the retractions and media attention, may play a role in the effectiveness of the reduction.

scholarly journals Assessing the impact of a restrictive opioid prescribing law in West Virginia

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Cara L. Sedney ◽  
Maryam Khodaverdi ◽  
Robin Pollini ◽  
Patricia Dekeseredy ◽  
Nathan Wood ◽  
...  
Keyword(s):  
Time Series ◽  
West Virginia ◽  
Moving Average ◽  
Monitoring Program ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Opioid Prescribing ◽  
Small Change ◽  
The Impact ◽  
First Time

Abstract Background The Opioid Reduction Act (SB 273) took effect in West Virginia in June 2018. This legislation limited ongoing chronic opioid prescriptions to 30 days’ supply, and first-time opioid prescriptions to 7 days’ supply for surgeons and 3 days’ for emergency rooms and dentists. The purpose of this study was to determine the effect of this legislation on reducing opioid prescriptions in West Virginia, with the goal of informing future similar policy efforts. Methods Data were requested from the state Prescription Drug Monitoring Program (PDMP) including overall number of opioid prescriptions, number of first-time opioid prescriptions, average daily morphine milligram equivalents (MME) and prescription duration (expressed as “days’ supply”) given to adults during the 64 week time periods before and after legislation enactment. Statistical analysis was done utilizing an autoregressive integrated moving average (ARIMA) interrupted time series analysis to assess impact of both legislation announcement and enactment while controlling secular trends and considering autocorrelation trends. Benzodiazepine prescriptions were utilized as a control. Results Our analysis demonstrates a significant decrease in overall state opioid prescribing as well as a small change in average daily MME associated with the date of the legislation’s enactment when considering serial correlation in the time series and accounting for pre-intervention trends. There was no such association found with benzodiazepine prescriptions. Conclusion Results of the current study suggest that SB 273 was associated with an average 22.1% decrease of overall opioid prescriptions and a small change in average daily MME relative to the date of legislative implementation in West Virginia. There was, however, no association of the legislation on first-time opioid prescriptions or days’ supply of opioid medication, and all variables were trending downward prior to implementation of SB 273. The control demonstrated no relationship to the law.

scholarly journals Assessing The Impact of A Restrictive Opioid Prescribing Law in West Virginia

2020 ◽  
Author(s):  
Cara L. Sedney ◽  
Maryam Khodaverdi ◽  
Robin Pollini ◽  
Patricia Dekeseredy ◽  
Nathan Wood ◽  
...  
Keyword(s):  
Time Series ◽  
West Virginia ◽  
Moving Average ◽  
Monitoring Program ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Emergency Rooms ◽  
Opioid Prescribing ◽  
The Impact ◽  
First Time

Abstract Background: The Opioid Reduction Act (SB 273) took effect in West Virginia in June 2018. This legislation limited ongoing chronic opioid prescriptions to 30 days’ supply, and first-time opioid prescriptions to 7 days’ supply for surgeons and 3 days’ for emergency rooms and dentists. The purpose of this study was to determine the effect of this legislation on reducing opioid prescriptions in West Virginia, with the goal of informing future similar policy efforts. Methods: Data were requested from the state Prescription Drug Monitoring Program (PDMP) including overall number of opioid prescriptions, number of first-time opioid prescriptions, average daily morphine milligram equivalents (MME) and prescription duration (expressed as “day’s supply”) given to adults during the 64 week time periods before and after legislation enactment. Statistical analysis was done utilizing an autoregressive integrated moving average (ARIMA) interrupted time series analysis to assess impact of both legislation announcement and enactment while controlling secular trends and considering autocorrelation trends. Benzodiazepine prescriptions were utilized as a control.Results: Our analysis demonstrates a statistically significant decrease in overall state opioid prescribing as well as average daily MME associated with the date of the legislation’s enactment when considering serial correlation in the time series and accounting for pre-intervention trends. There was no such association found with benzodiazepine prescriptions.Conclusion: Results of the current study suggest that SB 273 was associated with an average 22.1% decrease of overall opioid prescriptions and a small overall decrease of average daily MME relative to the date of legislative implementation in West Virginia. There was, however, no association of the legislation on first-time opioid prescriptions or days’ supply of opioid medication, and all variables were trending downward prior to implementation of SB 273. The control demonstrated no relationship to the law.

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