Does rural health system reform aimed at improving access to primary health care affect hospitalization rates? An interrupted time series analysis of national policy reforms in Iran

2019 ◽  
Vol 24 (2) ◽  
pp. 73-80 ◽  
Author(s):  
Arash Rashidian ◽  
Sedigheh Salavati ◽  
Hanan Hajimahmoodi ◽  
Mehrnaz Kheirandish
Keyword(s):  
Health Care ◽  
Time Series ◽  
Primary Health Care ◽  
Time Series Analysis ◽  
Rural Health ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Hospitalization Rates ◽  
Primary Health

Objectives To evaluate the effects of rural health insurance and family physician reforms on hospitalization rates in Iran. Methods An interrupted time series analysis of national monthly hospitalization rates in Iran (2003–2014), starting from two years before the intervention. Segmented regression analysis was used to assess the effects of the reforms on hospitalization rates. Results The analyses showed that hospitalization rates increased one year after the initiation of the reforms: 1.55 (95% CI: 1.24–1.86) additional hospitalizations per 1000 rural inhabitants per month (‘immediate effect’). This increase was followed by a further gradual increase of 0.034 per 1000 inhabitants per month (95% CI: 0.02–0.04). The gradual monthly increase continued for two years after the reforms. The higher hospitalization rates were maintained in the following years. We observed a significant increase in hospitalization rates at a national level in rural areas that continued for over 10 years after the policy implementation. Conclusion Primary health care reforms are often proposed for their efficiency outcomes (i.e. reduction in costs and use of hospitals) as well as their impact on improving health outcomes. We demonstrated that in populations with unmet needs, such reforms are likely to substantially increase hospitalization rates. This is an important consideration for successful design and implementation of interventions aimed at achieving universal health coverage in low- and middle-income countries.

scholarly journals A Smartphone App for Engaging Patients With Catheter-Associated Urinary Tract Infections: Protocol for an Interrupted Time-Series Analysis

10.2196/28314 ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. e28314
Author(s):  
Robbert Gerard Bentvelsen ◽  
Karin Ellen Veldkamp ◽  
Niels H Chavannes
Keyword(s):  
Health Care ◽  
Time Series ◽  
Time Series Analysis ◽  
Health Care Services ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Inappropriate Use ◽  
Series Analysis ◽  
Care Services ◽  
Tract Infections

Background Catheter-associated urinary tract infections (CAUTIs) are the main cause of health care–associated infections, and they increase the disease burden, antibiotic usage, and hospital stay. Inappropriate placement and unnecessarily prolonged usage of a catheter lead to an elevated and preventable risk of infection. The smartphone app Participatient has been developed to involve hospitalized patients in communication and decision-making related to catheter use and to control unnecessary (long-term) catheter use to prevent CAUTIs. Sustained behavioral changes for infection prevention can be promoted by empowering patients through Participatient. Objective The primary aim of our multicenter prospective interrupted time-series analysis is to reduce inappropriate catheter usage by 15%. We will evaluate the efficacy of Participatient in this quality improvement study in clinical wards. Our secondary endpoints are to reduce CAUTIs and to increase patient satisfaction, involvement, and trust with health care services. Methods We will conduct a multicenter interrupted time-series analysis—a strong study design when randomization is not feasible—consisting of a pre- and postintervention point-prevalence survey distributed among participating wards to investigate the efficacy of Participatient in reducing the inappropriate usage of catheters. After customizing Participatient to the wards’ requirements, it will be implemented with a catheter indication checklist among clinical wards in 4 large hospitals in the Netherlands. We will collect clinical data every 2 weeks for 6 months in the pre- and postintervention periods. Simultaneously, we will assess the impact of Participatient on patient satisfaction with health care services and providers and the patients’ perceived involvement in health care through questionnaires, and the barriers and facilitators of eHealth implementation through interviews with health care workers. Results To reduce the inappropriate use of approximately 40% of catheters (currently in use) by 15%, we aim to collect 9-12 data points from 70-100 patients per survey date per hospital. Thereafter, we will conduct an interrupted time-series analysis and present the difference between the unadjusted and adjusted rate ratios with a corresponding 95% CI. Differences will be considered significant when P<.05. Conclusions Our protocol may help reduce the inappropriate use of catheters and subsequent CAUTIs. By sharing reliable information and daily checklists with hospitalized patients via an app, we aim to provide them a tool to be involved in health care–related decision-making and to increase the quality of care. Trial Registration Netherlands Trial Register NL7178; https://www.trialregister.nl/trial/7178 International Registered Report Identifier (IRRID) DERR1-10.2196/28314

scholarly journals Impact of a national guideline on use of knee arthroscopy: An interrupted time-series analysis

2019 ◽  
Vol 31 (9) ◽  
pp. G113-G118
Author(s):  
Ali Kiadaliri ◽  
Dan Bergkvist ◽  
Leif E Dahlberg ◽  
Martin Englund
Keyword(s):  
Public Health ◽  
Health Care ◽  
Time Series ◽  
Time Series Analysis ◽  
Knee Arthroscopy ◽  
Interrupted Time Series ◽  
Public Health Care ◽  
Interrupted Time Series Analysis ◽  
Knee Oa ◽  
Series Analysis

Abstract Objective To assess the impact of the Swedish health authority recommendation against the use of knee arthroscopy in patients aged ≥40 years with knee osteoarthritis (OA). Design Interrupted time series analysis. Setting Public health care in Skåne region. Participants Patients aged ≥40 years who underwent knee arthroscopy from January 2010 to December 2015. Intervention(s) National guideline’s recommendation against the use of knee arthroscopy in patients with knee OA. Main Outcome Measure(s) 1) proportion of patients aged ≥40 years with a main diagnosis of Knee OA and/or degenerative meniscal lesions (DML) who underwent knee arthroscopy, and 2) overall knee arthroscopy rate per 100,000 Skåne population aged ≥40 years. Results A total of 6,155 knee arthroscopy were performed among people aged ≥40 years during study period. Of 42,044 patients with Knee OA/DML, 3,728 had knee arthroscopy. The recommendation was associated with reductions in the use of knee arthroscopy and two years after the recommendation, there was a reduction of 28.6% (95% CI: 9.3, 47.8) and 34.7% (23.9, 45.4) in proportion of Knee OA/DML patients with knee arthroscopy and the overall knee arthroscopy rate, respectively, relative to that expected if pre-recommendation trend continued. Our sensitivity analysis showed that the use of total knee replacement was stable over the study period. Conclusion The national recommendation was associated with reduction in use of knee arthroscopy in public health care in southern Sweden. However, still 4.5% of these patients underwent knee arthroscopy in 2015 implying that more efforts are required to achieve the recommended target.

scholarly journals A Smartphone App for Engaging Patients With Catheter-Associated Urinary Tract Infections: Protocol for an Interrupted Time-Series Analysis (Preprint)

2021 ◽  
Author(s):  
Robbert Gerard Bentvelsen ◽  
Karin Ellen Veldkamp ◽  
Niels H Chavannes
Keyword(s):  
Health Care ◽  
Time Series ◽  
Time Series Analysis ◽  
Health Care Services ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Inappropriate Use ◽  
Series Analysis ◽  
Care Services ◽  
Tract Infections

BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are the main cause of health care–associated infections, and they increase the disease burden, antibiotic usage, and hospital stay. Inappropriate placement and unnecessarily prolonged usage of a catheter lead to an elevated and preventable risk of infection. The smartphone app Participatient has been developed to involve hospitalized patients in communication and decision-making related to catheter use and to control unnecessary (long-term) catheter use to prevent CAUTIs. Sustained behavioral changes for infection prevention can be promoted by empowering patients through Participatient. OBJECTIVE The primary aim of our multicenter prospective interrupted time-series analysis is to reduce inappropriate catheter usage by 15%. We will evaluate the efficacy of Participatient in this quality improvement study in clinical wards. Our secondary endpoints are to reduce CAUTIs and to increase patient satisfaction, involvement, and trust with health care services. METHODS We will conduct a multicenter interrupted time-series analysis—a strong study design when randomization is not feasible—consisting of a pre- and postintervention point-prevalence survey distributed among participating wards to investigate the efficacy of Participatient in reducing the inappropriate usage of catheters. After customizing Participatient to the wards’ requirements, it will be implemented with a catheter indication checklist among clinical wards in 4 large hospitals in the Netherlands. We will collect clinical data every 2 weeks for 6 months in the pre- and postintervention periods. Simultaneously, we will assess the impact of Participatient on patient satisfaction with health care services and providers and the patients’ perceived involvement in health care through questionnaires, and the barriers and facilitators of eHealth implementation through interviews with health care workers. RESULTS To reduce the inappropriate use of approximately 40% of catheters (currently in use) by 15%, we aim to collect 9-12 data points from 70-100 patients per survey date per hospital. Thereafter, we will conduct an interrupted time-series analysis and present the difference between the unadjusted and adjusted rate ratios with a corresponding 95% CI. Differences will be considered significant when <i>P</i>&lt;.05. CONCLUSIONS Our protocol may help reduce the inappropriate use of catheters and subsequent CAUTIs. By sharing reliable information and daily checklists with hospitalized patients via an app, we aim to provide them a tool to be involved in health care–related decision-making and to increase the quality of care. CLINICALTRIAL Netherlands Trial Register NL7178; https://www.trialregister.nl/trial/7178 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/28314

scholarly journals Interrupted time-series analysis: studying trends in neurosurgery

2015 ◽  
Vol 39 (6) ◽  
pp. E6
Author(s):  
Ricky H. Wong ◽  
Fabrice Smieliauskas ◽  
I-Wen Pan ◽  
Sandi K. Lam
Keyword(s):  
Health Care ◽  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Services Research ◽  
Health Care Outcomes ◽  
Series Analysis ◽  
Care Outcomes ◽  
The Impact

OBJECT Neurosurgery studies traditionally have evaluated the effects of interventions on health care outcomes by studying overall changes in measured outcomes over time. Yet, this type of linear analysis is limited due to lack of consideration of the trend’s effects both pre- and postintervention and the potential for confounding influences. The aim of this study was to illustrate interrupted time-series analysis (ITSA) as applied to an example in the neurosurgical literature and highlight ITSA’s potential for future applications. METHODS The methods used in previous neurosurgical studies were analyzed and then compared with the methodology of ITSA. RESULTS The ITSA method was identified in the neurosurgical literature as an important technique for isolating the effect of an intervention (such as a policy change or a quality and safety initiative) on a health outcome independent of other factors driving trends in the outcome. The authors determined that ITSA allows for analysis of the intervention’s immediate impact on outcome level and on subsequent trends and enables a more careful measure of the causal effects of interventions on health care outcomes. CONCLUSIONS ITSA represents a significant improvement over traditional observational study designs in quantifying the impact of an intervention. ITSA is a useful statistical procedure to understand, consider, and implement as the field of neurosurgery evolves in sophistication in big-data analytics, economics, and health services research.

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