Timing Is Everything: The Utility of Time-Series Analysis to Capture Causality in Qualitative Case-Based Policy Inquiry

2018 ◽  
Vol 63 (3) ◽  
pp. 296-314
Author(s):  
Monica Reid Kerrigan ◽  
Ane Turner Johnson
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Policy Development ◽  
Meaning Making ◽  
Belief Systems ◽  
Policy Research ◽  
Qualitative Case Studies ◽  
Series Analysis ◽  
Quasi Experimental ◽  
Policy Inquiry

While policy researchers call for new approaches to support the analysis of complex policies, the dominance of experimental and quasi-experimental designs limits the field’s possibilities. Innovative yet rigorous qualitative methods have been overlooked, despite strong arguments by seminal qualitative methodologists about the appropriateness of qualitative research for inquiry situated in particular contexts and that recognizes the influence of time, place, people, and belief systems on outcomes. We argue that qualitative time-series analysis is one such overlooked approach that has greater potential for educational policy research because of its ability to address complexity in causal relationships. This article contributes to the policy and methodological literature in two ways: First, by providing a synthesis of available methodological literature on qualitative time-series analysis; and second, by providing two illustrative qualitative case studies that used different time-series approaches to examine policy development over time while accounting for the contextual factors and meaning-making that inform policy and shape the policy process. The article concludes with a discussion of the contribution of qualitative time-series analysis for policy research with examples from the cases.

scholarly journals Impact of Removal of Automatic 7-Day Stop Orders for Inpatient Antimicrobials

2020 ◽  
Vol 41 (S1) ◽  
pp. s264-s265
Author(s):  
Afia Adu-Gyamfi ◽  
Keith Hamilton ◽  
Leigh Cressman ◽  
Ebbing Lautenbach ◽  
Lauren Dutcher
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Treatment Interruptions ◽  
Days Of Therapy ◽  
Quasi Experimental ◽  
The Impact

Background: Automatic discontinuation of antimicrobial orders after a prespecified duration of therapy has been adopted as a strategy for reducing excess days of therapy (DOT) as part of antimicrobial stewardship efforts. Automatic stop orders have been shown to decrease antimicrobial DOT. However, inadvertent treatment interruptions may occur as a result, potentially contributing to adverse patient outcomes. To evaluate the effects of this practice, we examined the impact of the removal of an electronic 7-day ASO program on hospitalized patients. Methods: We performed a quasi-experimental study on inpatients in 3 acute-care academic hospitals. In the preintervention period (automatic stop orders present; January 1, 2016, to February 28, 2017), we had an electronic dashboard to identify and intervene on unintentionally missed doses. In the postintervention period (April 1, 2017, to March 31, 2018), the automatic stop orders were removed. We compared the primary outcome, DOT per 1,000 patient days (PD) per month, for patients in the automatic stop orders present and absent periods. The Wilcoxon rank-sum test was used to compare median monthly DOT/1,000 PD. Interrupted time series analysis (Prais-Winsten model) was used to compared trends in antibiotic DOT/1,000 PD and the immediate impact of the automatic stop order removal. Manual chart review on a subset of 300 patients, equally divided between the 2 periods, was performed to assess for unintentionally missed doses. Results: In the automatic stop order period, a monthly median of 644.5 antibiotic DOT/1,000 PD were administered, compared to 686.2 DOT/1,000 PD in the period without automatic stop orders (P < .001) (Fig. 1). Using interrupted time series analysis, there was a nonsignificant increase by 46.7 DOT/1,000 PD (95% CI, 40.8 to 134.3) in the month immediately following removal of automatic stop orders (P = .28) (Fig. 2). Even though the slope representing monthly change in DOT/1,000 PD increased in the period without automatic stop orders compared to the period with automatic stop orders, it was not statistically significant (P = .41). Manual chart abstraction revealed that in the period with automatic stop orders, 9 of 150 patients had 17 unintentionally missed days of therapy, whereas none (of 150 patients) in the period without automatic stop orders did. Conclusions: Following removal of the automatic stop orders, there was an overall increase in antibiotic use, although the change in monthly trend of antibiotic use was not significantly different. Even with a dashboard to identify missed doses, there was still a risk of unintentionally missed doses in the period with automatic stop orders. Therefore, this risk should be weighed against the modest difference in antibiotic utilization garnered from automatic stop orders.Funding: NoneDisclosures: None

scholarly journals Reduced dengue incidence following deployments of Wolbachia-infected Aedes aegypti in Yogyakarta, Indonesia: a quasi-experimental trial using controlled interrupted time series analysis

2020 ◽  
Author(s):  
Citra Indriani ◽  
Warsito Tantowijoyo ◽  
Edwige Rancès ◽  
Bekti Andari ◽  
Equatori Prabowo ◽  
...  
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Control Area ◽  
Northern Australia ◽  
Interrupted Time Series Analysis ◽  
Endemic Setting ◽  
Experimental Trial ◽  
Series Analysis ◽  
Quasi Experimental

AbstractBackgroundAe. aegypti mosquitoes stably transfected with the intracellular bacterium Wolbachia pipientis (wMel strain) have been deployed for the biocontrol of dengue and related arboviral diseases in multiple countries. Field releases in northern Australia have previously demonstrated near elimination of local dengue transmission from Wolbachia-treated communities, and pilot studies in Indonesia have demonstrated the feasibility and acceptability of the method. We conducted a quasi-experimental trial to evaluate the impact of scaled Wolbachia releases on dengue incidence in an endemic setting in Indonesia.Methods and findingsIn Yogyakarta City, Indonesia, following an extensive community engagement campaign, wMel Wolbachia-carrying mosquitoes were released every two weeks for 13–15 release rounds over seven months in 2016–17, in a contiguous 5 km2 area (population 65,000). A 3 km2 area (population 34,000) on the opposite side of the city was selected a priori as an untreated control area, on the basis of comparable socio-demographic characteristics and historical dengue incidence. Passive surveillance data on notified hospitalised dengue patients was used to evaluate the epidemiological impact of Wolbachia deployments, using controlled interrupted time series analysis. Rapid and sustained introgression of wMel Wolbachia into local Ae. aegypti populations was achieved. Thirty-four dengue cases were notified from the intervention area and 53 from the control area (incidence 26 vs 79 per 100,000 person-years) during the 24 months after Wolbachia was deployed. This corresponded in the regression model to a 73% reduction in dengue incidence (95% confidence interval 49%,86%) associated with the Wolbachia intervention. Exploratory analysis including an additional 6 months of post-intervention observations showed a small strengthening of this effect (30 vs 115 per 100,000 person-years; 76% reduction in incidence, 95%CI 60%,86%).ConclusionsThese findings demonstrate a significant reduction in dengue incidence following successful introgression of Wolbachia into local Ae. aegypti populations in an endemic setting in Indonesia. These results are consistent with previous field trials in northern Australia, and support the effectiveness of this novel approach for the control of dengue and other Aedes-borne diseases.

scholarly journals Exploring the Effects of Creating Small High Schools on Daily Attendance: A Statistical Case Study

2018 ◽  
Vol 15 (1) ◽  
Author(s):  
Matthijs Koopmans
Keyword(s):  
Time Series ◽  
High Schools ◽  
Time Series Analysis ◽  
Policy Research ◽  
Initial Increase ◽  
Post Intervention ◽  
Small High Schools ◽  
Series Analysis ◽  
School Year ◽  
Daily Attendance

Does creating small high schools have a beneficial impact on daily attendance? This question was addressed using time series analysis to examine the case of one urban transfer high school that serves students who previously dropped out of school. This analytical approach is uniquely suitable to examine the dynamical processes characterizing stability and transformation in the system. This school reduced its size from enrolling approximately 900 students up to and through the 2009-2010 school year to about 250 students afterward. We looked at whether attendance was higher after the intervention and whether it was more stable. It turns out that the attendance trajectories over a seven-year period show high volatility prior to the reduction in school size but are more stable afterward. The initial increase in daily attendance at the onset of the intervention is not maintained, but increases are observed later. The study illustrates the relevance of time series analysis for educational policy research as well as the use of complexity theory to fully appreciate the nature of the post intervention changes.

scholarly journals Impact of the WHO Framework Convention on Tobacco Control on global cigarette consumption: quasi-experimental evaluations using interrupted time series analysis and in-sample forecast event modelling

BMJ ◽  
2019 ◽  
pp. l2287 ◽  
Author(s):  
Steven J Hoffman ◽  
Mathieu J P Poirier ◽  
Susan Rogers Van Katwyk ◽  
Prativa Baral ◽  
Lathika Sritharan
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Tobacco Control ◽  
Interrupted Time Series ◽  
Cigarette Consumption ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Annual Consumption ◽  
Quasi Experimental ◽  
National Estimates

Abstract Objective To evaluate the impact of the WHO Framework Convention on Tobacco Control (FCTC) on global cigarette consumption. Design Two quasi-experimental impact evaluations, using interrupted time series analysis (ITS) and in-sample forecast event modelling. Setting and population 71 countries for which verified national estimates of cigarette consumption from 1970 to 2015 were available, representing over 95% of the world’s cigarette consumption and 85% of the world’s population. Main outcome measures The FCTC is an international treaty adopted in 2003 that aims to reduce harmful tobacco consumption and is legally binding on the 181 countries that have ratified it. Main outcomes were annual national estimates of cigarette consumption per adult from 71 countries since 1970, allowing global, regional, and country comparisons of consumption levels and trends before and after 2003, with counterfactual control groups modelled using pre-intervention linear time trends (for ITS) and in-sample forecasts (for event modelling). Results No significant change was found in the rate at which global cigarette consumption had been decreasing after the FCTC’s adoption in 2003, using either ITS or event modelling. Results were robust after realigning data to the year FCTC negotiations commenced (1999), or to the year when the FCTC first became legally binding in each country. By contrast to global consumption, high income and European countries showed a decrease in annual consumption by over 1000 cigarettes per adult after 2003, whereas low and middle income and Asian countries showed an increased annual consumption by over 500 cigarettes per adult when compared with a counterfactual event model. Conclusions This study finds no evidence to indicate that global progress in reducing cigarette consumption has been accelerated by the FCTC treaty mechanism. This null finding, combined with regional differences, should caution against complacency in the global tobacco control community, motivate greater implementation of proven tobacco control policies, encourage assertive responses to tobacco industry activities, and inform the design of more effective health treaties.

scholarly journals Reduced dengue incidence following deployments of Wolbachia-infected Aedes aegypti in Yogyakarta, Indonesia: a quasi-experimental trial using controlled interrupted time series analysis

2020 ◽  
Vol 4 ◽  
pp. 50 ◽  
Author(s):  
Citra Indriani ◽  
Warsito Tantowijoyo ◽  
Edwige Rancès ◽  
Bekti Andari ◽  
Equatori Prabowo ◽  
...  
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Control Area ◽  
Northern Australia ◽  
Interrupted Time Series Analysis ◽  
Endemic Setting ◽  
Experimental Trial ◽  
Series Analysis ◽  
Quasi Experimental

Background: Ae. aegypti mosquitoes stably transfected with the intracellular bacterium Wolbachia pipientis (wMel strain) have been deployed for biocontrol of dengue and related arboviral diseases in multiple countries. Field releases in northern Australia have previously demonstrated near elimination of local dengue transmission from Wolbachia-treated communities, and pilot studies in Indonesia have demonstrated the feasibility and acceptability of the method. We conducted a quasi-experimental trial to evaluate the impact of scaled Wolbachia releases on dengue incidence in an endemic setting in Indonesia. Methods: In Yogyakarta City, Indonesia, following extensive community engagement, wMel Wolbachia-carrying mosquitoes were released every two weeks for 13–15 rounds over seven months in 2016–17, in a contiguous 5 km2 area (population 65,000). A 3 km2 area (population 34,000) on the opposite side of the city was selected a priori as an untreated control area. Passive surveillance data on notified hospitalised dengue patients was used to evaluate the epidemiological impact of Wolbachia deployments, using controlled interrupted time-series analysis. Results: Rapid and sustained introgression of wMel Wolbachia into local Ae. aegypti populations was achieved. Thirty-four dengue cases were notified from the intervention area and 53 from the control area (incidence 26 vs 79 per 100,000 person-years) during 24 months following Wolbachia deployment. This corresponded in the regression model to a 73% reduction in dengue incidence (95% confidence interval 49%,86%) associated with the Wolbachia intervention. Exploratory analysis including 6 months additional post-intervention observations showed a small strengthening of this effect (30 vs 115 per 100,000 person-years; 76% reduction in incidence, 95%CI 60%,86%). Conclusions: We demonstrate a significant reduction in dengue incidence following successful introgression of Wolbachia into local Ae. aegypti populations in an endemic setting in Indonesia. These findings are consistent with previous field trials in northern Australia, and support the effectiveness of this novel approach for dengue control.

scholarly journals Regression based quasi-experimental approach when randomisation is not an option: interrupted time series analysis

BMJ ◽  
2015 ◽  
Vol 350 (jun09 5) ◽  
pp. h2750-h2750 ◽  
Author(s):  
E. Kontopantelis ◽  
T. Doran ◽  
D. A. Springate ◽  
I. Buchan ◽  
D. Reeves
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Experimental Approach ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Quasi Experimental

scholarly journals Impact of Generic Entry on Hospital Antimicrobial Use: A Retrospective Quasi-Experimental Interrupted Time Series Analysis

Antibiotics ◽  
2021 ◽  
Vol 10 (10) ◽  
pp. 1149
Author(s):  
Mercè Espona ◽  
Daniel Echeverria-Esnal ◽  
Sergi Hernandez ◽  
Alexander Almendral ◽  
Silvia Inés Gómez-Zorrilla ◽  
...  
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Economic Benefit ◽  
Interrupted Time Series ◽  
Antimicrobial Consumption ◽  
Interrupted Time Series Analysis ◽  
Generic Entry ◽  
Series Analysis ◽  
Quasi Experimental ◽  
The Impact

Background: The impact of antimicrobials generic entry (GE) is controversial. Their introduction could provide an economic benefit yet may also increase their consumption, leading to a higher risk of resistance. Our aim was to analyze the impact of GE on trends of antimicrobial consumption in an acute-care hospital. Methods: A retrospective quasi-experimental interrupted time series analysis was conducted at a 400-bed tertiary hospital in Barcelona, Spain. All antimicrobials for systemic use for which a generic product entered the hospital from January 2000 to December 2019 were included. Antimicrobial consumption was expressed as DDD/100 bed days. Results: After GE, the consumption of cefotaxime (0.09, p < 0.001), meropenem (0.54, p < 0.001), and piperacillin-tazobactam (0.13, p < 0.001) increased, whereas the use of clindamycin (−0.03, p < 0.001) and itraconazole (−0.02, p = 0.01) was reduced. An alarming rise in cefepime (0.004), daptomycin (1.02), and cloxacillin (0.05) prescriptions was observed, despite not achieving statistical significance. On the contrary, the use of amoxicillin (−0.07), ampicillin (−0.02), cefixime (−0.06), fluconazole (−0.13), imipenem–cilastatin (−0.50) and levofloxacin (−0.35) decreased. These effects were noticed beyond the first year post GE. Conclusions: GE led to an increase in the consumption of broad-spectrum molecules. The potential economic benefit of generic antibiotics could be diluted by an increase in resistance. Antimicrobial stewardship should continue to monitor these molecules despite GE.

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