Impact Evaluation of a Parolee-Based Focused Deterrence Program on Community-Level Violence

2018 ◽  
Vol 30 (9) ◽  
pp. 1408-1430 ◽  
Author(s):  
Kyleigh Clark-Moorman ◽  
Jason Rydberg ◽  
Edmund F. McGarrell
Keyword(s):  
Time Series ◽  
Intervention Program ◽  
Community Level ◽  
Synthetic Control ◽  
Post Intervention ◽  
Structural Time Series ◽  
Firearm Violence ◽  
Focused Deterrence ◽  
Quasi Experimental ◽  
The Impact

We estimate the impact of a parolee-based focused deterrence (“pulling levers”) intervention on community-level firearm and non-firearm violence in Rockford, Illinois, via a retrospective, quasi-experimental design. Focusing on incidents of firearm violence in Rockford over a period of 60 months (38 months pre-intervention, 22 months post-intervention), program impact is assessed using Bayesian Structural Time Series (BSTS) models, constructing a synthetic control-based counterfactual time series from National Incident-Based Reporting System (NIBRS) data from 59 non-treated cities of similar size. Relative to the synthetic control counterfactual, the intervention was associated with significant reductions in both firearm and non-firearm violence, particularly robberies, ranging from 6% to 30%. Consistent with research at other sites, these findings support the notion that focused deterrence strategies centered on high-risk parolees may result in reductions in firearm violence at the community level. The BSTS approach is a useful application for producing counterfactuals in retrospective quasi-experimental impact evaluations.

scholarly journals 1346. Implementation of a Multidisciplinary 48 Hour Antibiotic Timeout in a Pediatric Population

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S684-S684
Author(s):  
Victoria Konold ◽  
Palak Bhagat ◽  
Jennifer Pisano ◽  
Natasha N Pettit ◽  
Anish Choksi ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Intervention Group ◽  
Post Intervention ◽  
Days Of Therapy ◽  
New Antibiotics ◽  
Core Elements ◽  
Quasi Experimental ◽  
Empirical Antibiotics ◽  
The Impact

Abstract Background To meet the core elements required for antimicrobial stewardship programs, our institution implemented a pharmacy-led antibiotic timeout (ATO) process in 2017 and a multidisciplinary ATO process in 2019. An antibiotic timeout is a discussion and review of the need for ongoing empirical antibiotics 2-4 days after initiation. This study sought to evaluate both the multidisciplinary ATO and the pharmacy-led ATO in a pediatric population, compare the impact of each intervention on antibiotic days of therapy (DOT) to a pre-intervention group without an ATO, and to then compare the impact of the pharmacy-led ATO versus multidisciplinary ATO on antibiotic days of therapy (DOT). Methods This was a retrospective, pre-post, quasi-experimental study of pediatric patients comparing antibiotic DOT prior to ATO implementation (pre-ATO), during the pharmacy-led ATO (pharm-ATO), and during the multidisciplinary ATO (multi-ATO). The pre-ATO group was a patient sample from February-September 2016, prior to the initiation of a formal ATO. The pharmacy-led ATO was implemented from February-September 2018. This was followed by a multidisciplinary ATO led by pediatric residents and nurses from February-September 2019. Both the pharm-ATO and the multi-ATO were implemented as an active non-interruptive alert added to the electronic health record patient list. This alert triggered when new antibiotics had been administered to the patient for 48 hours, at which time, the responsible clinician would discuss the antibiotic and document their decision via the alert workspace. Pediatric patients receiving IV or PO antibiotics administered for at least 48 hours were included. The primary outcome was DOT. Secondary outcomes included length of stay (LOS) and mortality. Results 1284 unique antibiotic orders (n= 572 patients) were reviewed in the pre-ATO group, 868 (n= 323 patients) in the pharm-ATO and 949 (n= 305 patients) in the multi-ATO groups. Average DOT was not significantly different pre vs post intervention for either methodology (Table 1). Mortality was similar between groups, but LOS was longer for both intervention groups (Table 1). Impact of an ATO on DOT, Mortality and LOS Conclusion An ATO had no impact on average antibiotic DOT in a pediatric population, regardless of the ATO methodology. Disclosures All Authors: No reported disclosures

scholarly journals The Costs of Economic Nationalism: Evidence from the Brexit Experiment*

2019 ◽  
Vol 129 (623) ◽  
pp. 2722-2744 ◽  
Author(s):  
Benjamin Born ◽  
Gernot J Müller ◽  
Moritz Schularick ◽  
Petr Sedláček
Keyword(s):  
Synthetic Control ◽  
Control Methods ◽  
Economic Nationalism ◽  
Output Loss ◽  
Structural Time Series ◽  
Time Series Estimation ◽  
Series Estimation ◽  
Synthetic Control Methods ◽  
Quasi Experimental ◽  
Unexpected Outcome

Abstract Economic nationalism is on the rise, but at what cost? We study this question using the unexpected outcome of the Brexit referendum vote as a natural macroeconomic experiment. Employing synthetic control methods, we first show that the Brexit vote has caused a UK output loss of 1.7% to 2.5% by year-end 2018. An expectations-augmented VAR suggests that these costs are, to a large extent, driven by a downward revision of growth expectations in response to the vote. Linking quasi-experimental identification to structural time-series estimation allows us not only to quantify the aggregate costs but also to understand the channels through which expected economic disintegration impacts the macroeconomy.

scholarly journals An evaluation of Cognitive Stimulation Therapy sessions for people with dementia and a concomitant support group for their carers

Dementia ◽  
2016 ◽  
Vol 16 (8) ◽  
pp. 985-1003 ◽  
Author(s):  
Jan Bailey ◽  
Paul Kingston ◽  
Simon Alford ◽  
Louise Taylor ◽  
Edward Tolhurst
Keyword(s):  
Support Groups ◽  
Support Group ◽  
Qualitative Data ◽  
Cognitive Stimulation ◽  
Structured Interviews ◽  
Post Intervention ◽  
Cognitive Stimulation Therapy ◽  
People With Dementia ◽  
Quasi Experimental ◽  
The Impact

This research aimed to ascertain the impact of a pragmatic Cognitive Stimulation Therapy course of 10 sessions on the cognitive function of people living with dementia and whether attending a concomitant carers support group was beneficial to carers. A mixed method quasi-experimental approach was adopted; data were collected pre- and post-intervention. The quantitative arm utilised three validated questionnaires rated by the carers. Qualitative data were collected via semi-structured interviews with carers regarding their perceptions of the impact of Cognitive Stimulation Therapy and the carers support group. Quantitative data analysis found no statistically significant differences within or between groups. The qualitative data demonstrated that carers perceived Cognitive Stimulation Therapy had some benefits for the people living with dementia, especially social benefits. Carers also perceived that attending the carers support group was beneficial for them in terms of gaining a better understanding of dementia, developing coping skills and having peer support. The study was limited in scale and further research with a larger sample, using direct measures of the impact of Cognitive Stimulation Therapy with people living with dementia and supplementary research exploring which characteristic of carers support groups are effective would be worthwhile.

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

The Impact of Terms of Trade on the Export Structure of Manufactured Products in Different Economic Developing Status

2021 ◽  
Vol 1 (1) ◽  
pp. 59-67
Author(s):  
Kai-Ting Huang ◽  
Keyword(s):  
Time Series ◽  
Terms Of Trade ◽  
Development Status ◽  
Structural Time Series ◽  
Export Structure ◽  
Primary Products ◽  
Long Run ◽  
Deterministic Trend ◽  
Manufactured Products ◽  
The Impact

The Prebisch-Singer Hypothesis states that in structural time series analysis, the terms of trade between primary products and manufacturers have a negative deterministic trend. Many researchers argued that the deterioration in trade is the type of country in which the products are exported, regardless of whether the types of products exported by such countries are primary or manufactured products. This paper employs a development-differentiated model to analyze the correlation between various terms of trade and the export proportion of manufactured products on different economies of development status. In the long run, stable co-integration relations exist between terms of trade and the export proportion of manufactured products for development status. Furthermore, the increased proportion of manufactured products exports is the Granger casualty for the worse terms of trade for several economies of development status. The results demonstrated that changing the terms of trade is significantly influenced by structured changes in the export proportion of manufactured products for the development status of economies.

The Impact of an educational intervention on knowledge of attention-deficit hyperactivity disorder among primary school teachers in Lagos Nigeria

2015 ◽  
Vol 1 (1) ◽  
pp. 14-20
Author(s):  
I Adeosun ◽  
O Ogun ◽  
S Adeyemo ◽  
A Bello ◽  
O Fatiregun
Keyword(s):  
Primary School ◽  
Educational Intervention ◽  
Intervention Program ◽  
Psychological Treatment ◽  
Child And Adolescent Psychiatry ◽  
School Teachers ◽  
Post Intervention ◽  
Primary School Teachers ◽  
Children With Adhd ◽  
The Impact

Objective: Primary school teachers have been identified as important partners in the prompt recognition, referral and management of children with ADHD. However their capacity to function in these roles is hinged on their extent of knowledge about ADHD. Furthermore teachers' knowledge about ADHD may influence the education and clinical outcomes of children with ADHD. This study assessed the impact of an educational intervention program on knowledge about ADHD among primary school teachers in Lagos, Nigeria. Method: An experimental study of the impact of a brief educational intervention on ADHD literacy among primary school teachers (n=144) in Lagos, Nigeria. At baseline, knowledge about symptoms and treatment of ADHD was elicited with a vignette-based questionnaire. The intervention consisted of the administration of an educational leaflet about ADHD, designed by the American Academy of Child and Adolescent Psychiatry. One week post-intervention, the baseline assessments were repeated. Results: At baseline, 92.4% of the teachers could not recognise features of ADHD. The majority were also unaware of the role of teachers, medications and psychological interventions in the management of children with ADHD. Post-intervention, significantly greater number of respondents compared with baseline (88.0% vs. 7.6%) correctly identified symptoms of ADHD (p<0.005), and agreed that ADHD could be successfully managed with medications (63.2% vs. 9.0%; p<0.005) and psychological treatment (79.2% vs. 16.7%; p<0.005). Conclusion: A simple low-cost educational intervention is effective in improving knowledge about ADHD among primary school teachers in the shortterm. Further research is required to evaluate the impact of this intervention in the long term.

scholarly journals The effect of bariatric surgery on health care costs: A synthetic control approach using Bayesian structural time series

2019 ◽  
Vol 28 (11) ◽  
pp. 1293-1307
Author(s):  
Christoph F. Kurz ◽  
Martin Rehm ◽  
Rolf Holle ◽  
Christina Teuner ◽  
Michael Laxy ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Health Care ◽  
Time Series ◽  
Health Care Costs ◽  
Synthetic Control ◽  
Control Approach ◽  
Structural Time Series ◽  
Structural Time ◽  
Care Costs

scholarly journals Comprehensive geriatric assessment in the emergency department

2020 ◽  
Vol 49 (6) ◽  
pp. 936-938 ◽  
Author(s):  
Siobhan Harding
Keyword(s):  
Emergency Department ◽  
Secondary Care ◽  
Evidence Base ◽  
Community Dwelling ◽  
Multiple Sources ◽  
National Guidelines ◽  
Post Discharge ◽  
Post Intervention ◽  
Quasi Experimental ◽  
The Impact

Abstract Completing comprehensive geriatric assessments (CGA) for frail patients admitted to acute hospitals has well-established benefits and is advocated by national guidelines. There is high-quality evidence demonstrating an association between inpatient CGAs and the patient being alive and community-dwelling at 12-month follow-up. However, less well-known is the effectiveness of CGAs conducted within the emergency department (ED), with the primary purpose of facilitating admission avoidance, on reducing 30-day reattendance or readmission. This commentary provides an overview of five studies that measure the impact of conducting an ED-CGA on subsequent secondary care attendance. Two randomised-controlled trials, one case-matched cohort study and two quasi-experimental pre- and post-intervention studies were reviewed. The studies reported variable success in preventing subsequent secondary care use. No studies meeting the criteria had been conducted within the UK, affecting generalisability of the findings. There is no clear evidence that conducting a CGA within ED reduced reattendances or admissions 30 days post-discharge. The existing evidence base is methodologically and clinically heterogeneous and is vulnerable to multiple sources of bias. Further research is needed to understand whether screening to identify target populations or whether increased intensity of interventions delivered improves outcomes. ED-CGA may not have a beneficial effect on cost improvement or service delivery metrics, but it may have positive outcomes that are of high importance to the patients. This warrants further study.

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.

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