scholarly journals Impact of the national home safety equipment scheme ‘Safe At Home’ on hospital admissions for unintentional injury in children under 5: a controlled interrupted time series analysis

2021 ◽  
pp. jech-2021-216613
Author(s):  
Trevor Hill ◽  
Carol Coupland ◽  
Denise Kendrick ◽  
Matthew Jones ◽  
Ashley Akbari ◽  
...  
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Hospital Admissions ◽  
Unintentional Injury ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Home Safety ◽  
Safety Equipment ◽  
Admission Rates ◽  
Children Under 5

BackgroundUnintentional home injuries are a leading cause of preventable death in young children. Safety education and equipment provision improve home safety practices, but their impact on injuries is less clear. Between 2009 and 2011, a national home safety equipment scheme was implemented in England (Safe At Home), targeting high-injury-rate areas and socioeconomically disadvantaged families with children under 5. This provided a ‘natural experiment’ for evaluating the scheme’s impact on hospital admissions for unintentional injuries.MethodsControlled interrupted time series analysis of unintentional injury hospital admission rates in small areas (Lower Layer Super Output Areas (LSOAs)) in England where the scheme was implemented (intervention areas, n=9466) and matched with LSOAs in England and Wales where it was not implemented (control areas, n=9466), with subgroup analyses by density of equipment provision.Results57 656 homes receiving safety equipment were included in the analysis. In the 2 years after the scheme ended, monthly admission rates declined in intervention areas (−0.33% (−0.47% to −0.18%)) but did not decline in control areas (0.04% (−0.11%–0.19%), p value for difference in trend=0.001). Greater reductions in admission rates were seen as equipment provision density increased. Effects were not maintained beyond 2 years after the scheme ended.ConclusionsA national home safety equipment scheme was associated with a reduction in injury-related hospital admissions in children under 5 in the 2 years after the scheme ended. Providing a higher number of items of safety equipment appears to be more effective in reducing injury rates than providing fewer items.

scholarly journals Evaluation of the impact of the NICE head injury guidelines on inpatient mortality from traumatic brain injury: an interrupted time series analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e028912 ◽  
Author(s):  
Carl Marincowitz ◽  
Fiona Lecky ◽  
Victoria Allgar ◽  
Trevor Sheldon
Keyword(s):  
Time Series ◽  
Head Injury ◽  
Mortality Rate ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Age Group ◽  
Interrupted Time Series Analysis ◽  
Admission Rates ◽  
Series Analysis ◽  
The Impact

ObjectiveTo evaluate the impact of National Institute for Health and Care Excellence (NICE) head injury guidelines on deaths and hospital admissions caused by traumatic brain injury (TBI).SettingAll hospitals in England between 1998 and 2017.ParticipantsPatients admitted to hospital or who died up to 30 days following hospital admission with International Classification of Diseases (ICD) coding indicating the reason for admission or death was TBI.InterventionAn interrupted time series analysis was conducted with intervention points when each of the three guidelines was introduced. Analysis was stratified by guideline recommendation specific age groups (0–15, 16–64 and 65+).Outcome measuresThe monthly population mortality and admission rates for TBI.Study designAn interrupted time series analysis using complete Office of National Statistics cause of death data linked to hospital episode statistics for inpatient admissions in England.ResultsThe monthly TBI mortality and admission rates in the 65+ age group increased from 0.5 to 1.5 and 10 to 30 per 100 000 population, respectively. The increasing mortality rate was unaffected by the introduction of any of the guidelines.The introduction of the second NICE head injury guideline was associated with a significant reduction in the monthly TBI mortality rate in the 16–64 age group (-0.005; 95% CI: −0.002 to −0.007).In the 0–15 age group the TBI mortality rate fell from around 0.05 to 0.01 per 100 000 population and this trend was unaffected by any guideline.ConclusionThe introduction of NICE head injury guidelines was associated with a reduced admitted TBI mortality rate after specialist care was recommended for severe TBI. The improvement was solely observed in patients aged 16–64 years.The cause of the observed increased admission and mortality rates in those 65+ and potential treatments for TBI in this age group require further investigation.

scholarly journals Effects of an integrated respiratory service on Chronic Obstructive Pulmonary Disease hospital admissions in England: An interrupted time series analysis

2020 ◽  
pp. 135581962097405 ◽  
Author(s):  
Martha MC Elwenspoek ◽  
Tim Jones ◽  
James W Dodd
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Time Series ◽  
Length Of Stay ◽  
Time Series Analysis ◽  
Pulmonary Disease ◽  
Hospital Admissions ◽  
Interrupted Time Series ◽  
Chronic Obstructive ◽  
Interrupted Time Series Analysis ◽  
Obstructive Pulmonary Disease

Objectives To investigate the effects of an admission avoidance pathway within a new integrated respiratory service on the number of Chronic Obstructive Pulmonary Disease (COPD)-related hospital admissions in England. Methods We used interrupted time series analysis to estimate the effects of the admission avoidance pathway on COPD hospital admissions, length of stay, and 30-day readmissions. We included all unplanned admissions with COPD as primary diagnosis using Hospital Episode Statistics, comparing the intervention region with a demographically similar control region in the two years before and one year after the implementation of the new service. Results Unplanned hospital admissions for COPD exacerbations followed a clear seasonal pattern, peaking in early winter. We found no evidence that the admission avoidance pathway influenced the rate of hospital admissions or 30-day readmissions. We found weak evidence of a trend change in length of stay following the launch of the admission avoidance pathway. Conclusions Our study adds to the growing body of evidence that suggests that additional admission avoidance capacity alone does not lead to a measurable reduction in admissions or length of stay. Further investigation is required to understand the reasons why. A longer follow-up may be required to see some of the potential benefits.

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

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.

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

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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