Daily Bicycle and Pedestrian Activity as an Indicator of Disaster Recovery: A Hurricane Harvey Case Study

Changes in levels and patterns of physical activity might be a mechanism to assess and inform disaster recovery through the lens of wellbeing. However, few studies have examined disaster impacts on physical activity or the potential for physical activity to serve as an indicator of disaster recovery. In this exploratory study, we examined daily bicycle and pedestrian counts from four public bicycle/pedestrian trails in Houston, before and after Hurricane Harvey landfall, to assess if physical activity returned to pre-Harvey levels. An interrupted time series analysis was conducted to examine the immediate impact of Harvey landfall on physical activity; t-tests were performed to assess if trail usage returned to pre-Harvey levels. Hurricane Harvey was found to have a significant negative impact on daily pedestrian and bicycle counts for three of the four trails. Daily pedestrian and bicycle counts were found to return to pre-Harvey or higher levels at 6 weeks post-landfall at all locations studied. We discuss the potential for further research to examine the trends, feasibility, validity, and limitations of using bicycle and pedestrian use levels as a proxy for disaster recovery and wellbeing among affected populations.

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A mixed methods study of the impact of consultant overnight working in an English Emergency Department

Emergency Medicine Journal ◽

10.1136/emermed-2018-207571 ◽

2018 ◽

Vol 36 (5) ◽

pp. 298-302 ◽

Cited By ~ 2

Author(s):

Marion L Penn ◽

Thomas Monks ◽

Catherine Pope ◽

Mike Clancy

Keyword(s):

Negative Impact ◽

Waiting Times ◽

Interrupted Time Series ◽

Well Being ◽

Night Work ◽

University Hospital ◽

Interrupted Time Series Analysis ◽

Additional Time ◽

Before And After ◽

The Impact

BackgroundThere is a growing expectation that consultant-level doctors should be present within an ED overnight. However, there is a lack of robust evidence substantiating the impact on patient waiting times, safety or the workforce.ObjectivesTo evaluate the impact of consultant-level doctors overnight working in ED in a large university hospital.MethodsWe conducted a controlled interrupted time series analysis to study ED waiting times before and after the introduction of consultant night working. Adverse event reports (AER) were used as a surrogate for patient safety. We conducted interviews with medical and nursing staff to explore attitudes to night work.ResultsThe reduction seen in average time in department relative to the day, following the introduction of consultant was non-significant (−12 min; 95% CI −28 to 4, p=0.148). Analysis of hourly arrivals and departures indicated that overnight work was inherited from the day. There were three (0.9%) moderate and 0 severe AERs in 1 year. The workforce reported that night working had a negative impact on sleep patterns, performance and well-being and there were mixed views about the benefits of consultant night presence. Additional time off during the day acted as compensation for night work but resulted in reduced contact with ED teams.ConclusionsOur single-site study was unable to demonstrate a clinically important impact of consultant night working on total time patients spend in the department. Our analysis suggests there may be more potential to reduce total time in department during the day, at our study site. Negative impacts on well-being, and likely resistance to consultant night working should not be ignored. Further studies of night working are recommended to substantiate our results.

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Impact of Legislation on Opioid Prescribing following Hysterectomy and Hysteroscopy in Arizona and Florida

Gynecologic and Obstetric Investigation ◽

10.1159/000519517 ◽

2021 ◽

pp. 1-9

Author(s):

Aakriti R. Carrubba ◽

Amy E. Glasgow ◽

Elizabeth B. Habermann ◽

Amanda P. Stanton ◽

Megan N. Wasson ◽

...

Keyword(s):

Statistical Analysis ◽

Cohort Analysis ◽

Oral Morphine ◽

Interrupted Time Series ◽

Interrupted Time Series Analysis ◽

Opioid Use ◽

Prescribing Practices ◽

Opioid Prescribing ◽

Before And After ◽

Legislative Changes

Objectives: This study aimed to determine the oral morphine equivalents (OMEs) prescribed and refill rates following hysterectomy and hysteroscopy in the setting of opioid prescribing practice changes in 2 states. Design: This is a retrospective cohort analysis consisting of 2,916 patients undergoing hysterectomy or hysteroscopy between July 2016 and September 2019 at 2 affiliated academic hospitals in states that underwent legislative changes in opioid prescribing in 2018. Methods: Participants were identified using the Current Procedural Terminology procedure codes in Arizona and Florida. Hysterectomy was chosen as the most invasive gynecologic procedure, while hysteroscopy was chosen as the least invasive. Medical records were abstracted to find opioid prescriptions from 90 days before surgery to 30 days after discharge. Patients with opioid use between 90 and 7 days before surgery were excluded. Prescriptions were converted to OMEs and were calculated per quarter year. Statistical analysis included Wilcoxon rank sum t tests for OMEs and χ2 t tests for refill rates. Interrupted time-series analysis was used to determine significant change in OMEs before and after legislative change. Statistical analysis was performed using SAS version 9.4 (SAS Institute, Cary, NC, USA). Results: In Arizona, 1,067 hysterectomies were performed; 459 (43%) vaginal, 561 (52.6%) laparoscopic/robotic, and 47 (4.4%) abdominal. There were 530 hysteroscopies. Overall median OMEs decreased from 225 prior to July 2018 to 75 after July 2018 (p < 0.0001). The opioid refill rate remained unchanged at 7.4% (p = 0.966). In Florida, there were 769 hysterectomies; 241 (31.3%) vaginal, 476 (61.9%) laparoscopic/robotic, and 52 (6.8%) abdominal. There were 549 hysteroscopies. Overall median OMEs decreased from 150 prior to July 2018 to 0 after July 2018 (p < 0.0001). The opioid refill rate was similar (7.8% before July 2018 and 7.3% after July 2018; p = 0.739). Limitations: Limitations include involvement of a single hospital institution with a total of 10 fellowship-trained surgeons and biases inherent to retrospective study design. Conclusions: Legislative and provider-led changes coincided with decreases in opioid prescribing after 2018 in both states without increasing rates of refills and showed actual data reflected in the medical record. Gynecologists must actively participate in safe prescribing practices to decrease opioid dependence and misuse.

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Legacies of a mega sporting event for healthy adolescent development: a case study of the 2010 Vancouver Olympic and Paralympic Games

10.7190/shu-thesis-00313 ◽

2020 ◽

Author(s):

◽

Ann Smith

Keyword(s):

Physical Activity ◽

Adolescent Development ◽

Homeless Youth ◽

Negative Impact ◽

Sports Participation ◽

Sporting Events ◽

Healthy Adolescent ◽

Sporting Event ◽

The Impact

Numerous studies have considered the impact of hosting a mega sporting event on adults. Using the 2010 Vancouver Winter Olympics and Paralympics as a case study, this thesis is the first to consider the impact of such an event on adolescents over a decade pre and post the event. It investigates the legacies of the 2010 Games on physical activity, employment, and community connectedness, and the environmental, psychological and social mechanisms through which any legacies may have occurred. A mixed-methods approach was used which combined analyses of cross-sectional data from the BC Adolescent Health Survey and Homeless and Street Involved Youth Survey, with sports club membership data and stakeholder consultations. Using selfreport data from over 60,000 adolescents—including three subpopulations typically excluded from mega events (adolescents with a disability, experiencing homelessness, and at risk of incarceration)—the study considered positive and negative, planned and unplanned, tangible and intangible legacies, and the time and space in which they occurred (Preuss, 2016). Results differed by age, gender and location. For example, the 2010 Games were more likely to have both a positive and negative impact on homeless youth in host communities compared to non-host communities. However, across British Columbia, a positive perception of the Games’ impact was associated with regular physical activity. Vulnerable subpopulations generally reported more negative impacts of the Games, but those who reported positive impacts experienced some reduction in health disparities with the general population. However, rather than serving as a catalyst to close the gap in organised sports participation between adolescents with a physical disability and their peers, the disparity increased following the Games. Stakeholder consultations provided context to these findings, and offered insight into how future mega sporting events might be leveraged to support healthy adolescent development at the population and subpopulation level.

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Digital cognitive behavioural therapy for insomnia and primary care costs in England: an interrupted time series analysis

BJGP Open ◽

10.3399/bjgpo.2021.0146 ◽

2021 ◽

pp. BJGPO.2021.0146

Author(s):

Chris Sampson ◽

Eleanor Bell ◽

Amanda Cole ◽

Christopher B Miller ◽

Tracey Marriott ◽

...

Keyword(s):

Primary Care ◽

Time Series ◽

Cognitive Behavioural Therapy ◽

Interrupted Time Series ◽

Behavioural Therapy ◽

Interrupted Time Series Analysis ◽

Cognitive Behavioural ◽

Before And After ◽

Quasi Experimental ◽

Care Costs

BackgroundSleepio is an automated digital programme that delivers cognitive behavioural therapy for insomnia (dCBT-I). Sleepio has been proven effective in improving sleep difficulties. However, evidence for the possible impact of Sleepio use on health care costs in the United Kingdom has not previously been developed.AimWe sought to identify the effect of a population-wide rollout of Sleepio in terms of primary care costs in the National Health Service (NHS) in England.Design & settingThe study was conducted in the Thames Valley region of England, where access to Sleepio was made freely available to all residents between October 2018 and January 2020. The study relies on a quasi-experimental design, using an interrupted time series to compare the trend in primary care costs before and after the rollout of Sleepio.MethodWe use primary care data for people with relevant characteristics from nine general practices in Buckinghamshire. Primary care costs include general practice contacts and prescriptions. Segmented regression analysis was used to estimate primary and secondary outcomes.ResultsFor the 10,704 patients included in our sample, the total saving over the 65-week follow-up period was £71,027. This corresponds to £6.64 per person in our sample or around £70.44 per Sleepio user. Secondary analyses suggest that savings may be driven primarily by reductions in prescribing.ConclusionSleepio rollout reduced primary care costs. National adoption of Sleepio may reduce primary care costs by £20 million in the first year. The expected impact on primary care costs in any particular setting will depend on the uptake of Sleepio.

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ED syphilis and gonorrhea/chlamydia cotesting practices before and after the implementation of an electronic health record-based alert

Emergency Medicine Journal ◽

10.1136/emermed-2020-210331 ◽

2021 ◽

pp. emermed-2020-210331

Author(s):

James S Ford ◽

Tasleem Chechi ◽

Michella Otmar ◽

Melissa Baker ◽

Sarah Waldman ◽

...

Keyword(s):

Electronic Health Record ◽

Underserved Populations ◽

Cohort Analysis ◽

Treponema Pallidum ◽

Interrupted Time Series ◽

Health Record ◽

Interrupted Time Series Analysis ◽

Syphilis Testing ◽

Before And After ◽

Electronic Health

BackgroundThe prevalence of syphilis is increasing in many countries, including the USA. The ED is often used by underserved populations, making it an important setting to test and treat patients who are not evaluated in outpatient clinical settings. We aimed to assess the utility of an ED-based syphilis and gonorrhoea/chlamydia cotesting protocol by comparing testing practices before and after its implementation.MethodsWe implemented an electronic health record (EHR) alert that prompted clinicians to order syphilis testing in patients undergoing gonorrhoea/chlamydia testing. We performed a retrospective cohort analysis that compared outcomes between the preimplementation period (January–November 2018) and the postimplementation period (January–November 2019). Patients were tested for Treponema pallidum antibody (TPA) using a multiplex flow immunoassay (MFI), and positive results were confirmed by rapid plasma reagin (RPR). The primary implementation outcome was the number of syphilis tests/month, and the primary clinical outcome was the number of syphilis diagnoses/month (defined as positive TPA MFI and RPR). We performed an interrupted time-series analysis to evaluate the effect of implementing the alert over time.ResultsFour-hundred and ninety-four and 1106 unique patients were tested for syphilis in the preimplementation and postimplementation periods, respectively. Syphilis testing increased by 55.6 tests/month (95% CI 45.9 to 65.3, p<0.001) following alert implementation. Patients tested in the postimplementation period who were tested using the alert were much younger (difference: 14 years (95% CI 12 to 15)) and were more likely to be female (difference: 15% (95% CI 8 to 21)) and African-American (difference: 11% (95% CI 5 to 17)) than patients tested by clinician-initiated testing. Presumptive syphilis diagnoses increased from 3.4 diagnoses/month to 7.9 diagnoses/month (difference, 4.5 (95% CI 2.2 to 6.9), p<0.001).ConclusionsOur study demonstrates that use of a targeted EHR alert testing protocol can increase syphilis testing and diagnosis and may reduce clinician bias in testing.

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The Impact of the Change in Payment System for German Psychiatric Clinics on Treatment Success: An Interrupted Time Series Analysis

Das Gesundheitswesen ◽

10.1055/a-0828-7504 ◽

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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The impact of implementing the 2016 WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience on perinatal deaths: an interrupted time-series analysis in Mpumalanga province, South Africa

BMJ Global Health ◽

10.1136/bmjgh-2020-002965 ◽

2020 ◽

Vol 5 (12) ◽

pp. e002965

Author(s):

Tina Lavin ◽

Robert Clive Pattinson ◽

Erin Kelty ◽

Yogan Pillay ◽

David Brian Preen

Keyword(s):

Time Series ◽

Time Series Analysis ◽

Perinatal Mortality ◽

Interrupted Time Series ◽

Interrupted Time Series Analysis ◽

Neonatal Deaths ◽

Series Analysis ◽

Before And After ◽

Implementation Period ◽

Early Neonatal Deaths

ObjectivesTo investigate if the implementation of the 2016 WHO Recommendations for a Positive Pregnancy Experience reduced perinatal mortality in a South African province. The recommendations were implemented which included increasing the number of contacts and also the content of the contacts.MethodsRetrospective interrupted time-series analysis was conducted for all women accessing a minimum of one antenatal care contact from April 2014 to September 2019 in Mpumalanga province, South Africa. Retrospective interrupted time-series analysis of province level perinatal mortality and birth data comparing the pre-implementation period (April 2014–March 2017) and post-implementation period (April 2018–September 2019). The main outcome measure was unadjusted prevalence ratio (PR) for perinatal deaths before and after implementation; interrupted time-series analyses for trends in perinatal mortality before and after implementation; stillbirth risk by gestational age; primary cause of deaths (and maternal condition) before and after implementation.ResultsOverall, there was a 5.8% absolute decrease in stillbirths after implementation of the recommendations, however this was not statistically significant (PR 0.95, 95% CI 0.90% to 1.05%; p=0.073). Fresh stillbirths decreased by 16.6% (PR 0.86, 95% CI 0.77% to 0.95%; p=0.003) while macerated stillbirths (p=0.899) and early neonatal deaths remained unchanged (p=0.499). When stratified by weight fresh stillbirths >2500 g decreased by 17.2% (PR 0.81, 95% CI 0.70% to 0.94%; p=0.007) and early neonatal deaths decreased by 12.8% (PR 0.88, 95% CI 0.77% to 0.99%; p=0.041). The interrupted time-series analysis confirmed a trend for decreasing stillbirths at 0.09/1000 births per month (−0.09, 95% CI −1.18 to 0.01; p=0.059), early neonatal deaths (−0.09, 95% CI −0.14 to 0.04; p=<0.001) and perinatal mortality (−1.18, 95% CI −0.27 to −0.09; p<0.001) in the post-implementation period. A decrease in stillbirths, early neonatal deaths or perinatal mortality was not observed in the pre-implementation period. During the period when additional antenatal care contacts were implemented (34–38 weeks), there was a decrease in stillbirths of 18.4% (risk ratio (RR) 0.82, 95% CI 0.73% to 0.91%, p=0.0003). In hypertensive disorders of pregnancy, the risk of stillbirth decreased in the post-period by 15.1% (RR 0.85; 95% CI 0.76% to 0.94%; p=0.002).ConclusionThe implementation of the 2016 WHO Recommendations for a Positive Pregnancy Experience may be an effective public health strategy to reduce stillbirths in South African provinces.

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Vancomycin Use: Room for Improvement Among Hospitalized Children

Journal of Pharmacy Practice ◽

10.1177/0897190016635478 ◽

2016 ◽

Vol 30 (3) ◽

pp. 296-299 ◽

Cited By ~ 8

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.

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Improving the Recording of Diagnoses in Primary Care with Team Incentives: A Controlled Longitudinal Follow-Up Study

BioMed Research International ◽

10.1155/2018/4606710 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7

Author(s):

Tuomo Lehtovuori ◽

Timo Kauppila ◽

Jouko Kallio ◽

Anna M. Heikkinen ◽

Marko Raina ◽

...

Keyword(s):

Primary Care ◽

Interrupted Time Series ◽

Interrupted Time Series Analysis ◽

Follow Up Study ◽

Primary Care Teams ◽

Before And After ◽

Quasi Experimental ◽

Clinically Significant ◽

Made In

Introduction. We studied whether primary care teams respond to financial group bonuses by improving the recording of diagnoses, whether this intervention leads to diagnoses reflecting the anticipated distribution of diseases, and how the recording of a significant chronic disease, diabetes, alters after the application of these bonuses. Methods. We performed an observational register-based retrospective quasi-experimental follow-up study with before-and-after setting and two control groups in primary healthcare of a Finnish town. We studied the rate of recorded diagnoses in visits to general practitioners with interrupted time series analysis. The distribution of these diagnoses was also recorded. Results. After group bonuses, the rate of recording diagnoses increased by 17.9% (95% CI: 13.6–22.3) but not in either of the controls (−2.0 to −0.3%). The increase in the rate of recorded diagnoses in the care teams varied between 14.9% (4.7–25.2) and 33.7% (26.6–41.3). The distribution of recorded diagnoses resembled the respective distribution of diagnoses in the former studies of diagnoses made in primary care. The rate of recorded diagnoses of diabetes did not increase just after the intervention. Conclusions. In primary care, the completeness of diagnosis recording can be, to varying degrees, influenced by group bonuses without guarantee that recording of clinically significant chronic diseases is improved.

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