Intervention Characteristics Considered in Health Educators’ Adoption Decision-Making Process

It is well known that perceptions of intervention characteristics (e.g., cost, source, evidence strength and quality) are a critical link from dissemination to implementation. What is less known is the process by which researchers understand the characteristics most valued by key intermediaries (i.e., real-world decision-makers), particularly in the federal system of Cooperative Extension. In Extension, university-based specialists are available to assist county-based agents in program selection, delivery, and evaluation. For this work, a sequential explanatory mixed-methods design was used to conduct surveys and semi-structured interviews, informed by the Diffusion of Innovations theory and Consolidated Framework for Implementation Research. Educators and specialists were recruited across 47 states to identify characteristics of health promotion interventions that facilitate the adoption decision-making process. Analysis of intervention attribute importance survey data was conducted through a one-way ANOVA with Bonferroni post hoc test to determine individual variable differences between responses. Interviews underwent a conventional content analysis. In total, 121 educators and 47 specialists from 33 states completed the survey. Eighteen educators and 10 specialists completed interviews. Educators and specialists valued components such as the community need for the intervention, and potential reach compared with other components including previous delivery settings and external funding of the intervention ( p < .05). Qualitative data indicated divergence between educators and specialists; educators valued understanding the intervention cost (time and training) and specialists valued the evidence base and external funding available. Intervention developers should communicate information valued by different stakeholders to improve the adoption of evidence-based interventions.

The Efficacy and Cost-Effectiveness of Replacing Whole Apples with Sliced in the National School Lunch Program

The National School Lunch Program (NSLP) serves 29.6 million lunches each day. Schools must offer ½ a cup of fruit for each lunch tray. Much of this fruit may be wasted, leaving the schools in a dilemma. The objectives of this study were to evaluate the consumption of whole vs. sliced apples and determine the cost-effectiveness of the intervention. Researchers weighed apple waste at baseline and three post-intervention time points in one rural Midwest school. The costs of the intervention were collected from the school. The cost-effectiveness analysis estimates how often apples need to be served to offset the costs of the slicing intervention. A total of (n = 313) elementary student students participated. Students consumed significantly more sliced as compared to whole apples in intervention months 3 (β = 21.5, p < 0.001) and 4 (β = 27.7, p < 0.001). The intervention cost was USD 299. The value of wasted apple decreased from USD 0.26 at baseline to USD 0.23 wasted at post-intervention. The school would need to serve 9403 apples during the school year (54 times) to cover the expenses of the intervention. In conclusion, serving sliced apples may be a cost-effective way to improve fruit consumption during school lunch.

An age-structured SEIR model for COVID-19 incidence in Dublin, Ireland with framework for evaluating health intervention cost

Strategies adopted globally to mitigate the threat of COVID–19 have primarily involved lockdown measures with substantial economic and social costs with varying degrees of success. Morbidity patterns of COVID–19 variants have a strong association with age, while restrictive lockdown measures have association with negative mental health outcomes in some age groups. Reduced economic prospects may also afflict some age cohorts more than others. Motivated by this, we propose a model to describe COVID–19 community spread incorporating the role of age-specific social interactions. Through a flexible parameterisation of an age-structured deterministic Susceptible Exposed Infectious Removed (SEIR) model, we provide a means for characterising different forms of lockdown which may impact specific age groups differently. Social interactions are represented through age group to age group contact matrices, which can be trained using available data and are thus locally adapted. This framework is easy to interpret and suitable for describing counterfactual scenarios, which could assist policy makers with regard to minimising morbidity balanced with the costs of prospective suppression strategies. Our work originates from an Irish context and we use disease monitoring data from February 29th 2020 to January 31st 2021 gathered by Irish governmental agencies. We demonstrate how Irish lockdown scenarios can be constructed using the proposed model formulation and show results of retrospective fitting to incidence rates and forward planning with relevant “what if / instead of” lockdown counterfactuals. Uncertainty quantification for the predictive approaches is described. Our formulation is agnostic to a specific locale, in that lockdown strategies in other regions can be straightforwardly encoded using this model.

PP146 Use Of Carbon Dioxide In Endovascular Surgery To Prevent Contrast-Induced Nephropathy

IntroductionInterventional procedures often use iodinated contrast media (ICM) to visualize the area of interest. However, the use of ICM can cause contrast-induced nephropathy (CIN), which is a frequent complication after catheterization and is associated with morbidity and mortality. CIN is also a common complication in patients with pre-existing chronic kidney disease, diabetes, and heart failure. The purpose of this analysis was to compare carbon dioxide (CO2) with conventional contrast agents.MethodsTo assess the clinical effectiveness of CO2 in preventing CIN, a systematic review of relevant literature, including international guidelines, from the Medline database was conducted. Imaging of the chest, aorta, coronary arteries, and cerebral circulation with CO2 is limited, so effectiveness was determined in the field of renal and peripheral artery angioplasty. The effect on intervention cost was the main outcome.ResultsUse of CO2 generally reduced renal toxicity and anaphylactic reaction, but the benefits remain controversial. Angiography with CO2 is reasonable when image accuracy is not crucial due to its low informative value. Strategies for preventing acute kidney injury demonstrated the effectiveness of sodium chloride administration before and after the procedure. Additionally, the absence of risk factors for kidney disease significantly reduced the risk of impaired renal function.ConclusionsAlthough CO2 is one of the alternative methods for visualization, it is not pivotal in preventing CIN, even though the manufacturers recommend CO2 as the preferred contrast agent in patients with renal insufficiency who are allergic to ICM. The economic indicators for the use of CO2 are similar to traditional visualization methods.

48. Local Implementation of an Antibiotic Stewardship Intervention for Asymptomatic Bacteriuria Through Centralized Facilitation Required Minimal Costs and Effort

Background The cost of an antibiotic stewardship intervention is an important yet often neglected factor in antibiotic stewardship research. We studied the costs associated with successful implementation of the “Kicking CAUTI” intervention to decrease treatment of asymptomatic bacteriuria (ASB). Methods A central coordinating site facilitated roll-out of an audit and feedback intervention to decrease unnecessary urine cultures and antibiotic treatment in patients with ASB in four Veterans Affairs medical centers. Each site had a physician site champion, a part-time research coordinator, and 1-2 additional participants (often pharmacists). Participants kept weekly time-logs to collect the minutes associated with intervention tasks, and percent full-time effort (FTE) and costs were computed. For weeks with missing logs the average minutes for each activity associated with each type of professional was imputed. Salary information was obtained from the Bureau of Labor Statistics and Association of American Medical Colleges. Results Research coordinator time comprised of majority of the personnel time, followed by the physician site champions (Figure 1). Each intervention site required about 10% FTE/year of a research coordinator, and 3.5% FTE/year and 3.8% FTE/year of a physician and pharmacist respectively. The coordinating site required 37% FTE/year of a research coordinator, and 9% FTE of a physician to spearhead the intervention. Research coordinators predominantly spent their time on chart-reviews and project coordination. Physician champions predominantly spent their time on delivering audit and feedback and project coordination. The intervention cost USD 22,299/year per site on average, and USD 45,359/year for the coordinating site. Conclusion The Kicking CAUTI intervention was successful at reducing urine cultures and associated antibiotic use, with minimal time from the local team members. The research coordinators’ time was primarily spent on collection of research data, which will not be necessary outside of a research project. Our model of centralized facilitation makes economic sense for widespread scale-up and dissemination of antibiotic stewardship interventions in integrated healthcare systems. Disclosures Barbara Trautner, MD, PhD, Genentech (Consultant, Scientific Research Study Investigator)

Audit feedback interventions to address high-risk prescriptions in long-term care homes: a costing study and return on investment analysis

Background Audit and feedback is a common implementation strategy, but few studies describe its costs. ‘MyPractice’ is a province-wide audit and feedback initiative to improve prescribing in nursing homes. This study sought to estimate the costs of ‘MyPractice’ and assess whether the financial benefit of ‘MyPractice’ offsets those costs. Methods We conducted a costing study from the perspective of the Ontario government. Total cost of ‘MyPractice’ was calculated as the sum of the costs of producing and disseminating the reports (covering three report releases) which were obtained from Ontario Health staff interviews and document reviews. Return on investment (ROI) was calculated as the ratio of net cost-savings and the intervention cost. Cost savings were based on the effectiveness of ‘MyPractice’ derived from a published cohort study. Cost-savings attributable to ‘MyPractice’ were estimated from the changes in the rates of antipsychotics over time between physicians who signed up and viewed the reports and those who did not sign up to the reports. Results Total intervention costs were C$223,691 (C$838 per physician and C$74,564 per release). Costs incurred during the development phase accounted for 74% of the total cost (C$166,117), while implementation costs for three report releases were responsible for 26% of the total costs (C$57,575). The ROI for every C$1 spent on the ‘MyPractice’ intervention was 1.02 (95% CI 0.51, 1.93) for three report releases. Conclusion ‘MyPractice’ report offers a good return on investment and the value for money could improve with greater number of report releases.

Evaluation of the Healthy Living after Cancer text message-delivered, extended contact intervention using the RE-AIM framework

Background Text message-delivered interventions have potential to prevent weight regain and maintain diet and physical activity behaviours through extending contact with participants following initial weight loss, lifestyle interventions. Using the RE-AIM Framework, this study evaluated the adoption, reach, implementation, effectiveness, and maintenance of an extended contact text-message intervention following the Healthy Living after Cancer (HLaC) program. HLaC was a 6-month, telephone-delivered intervention targeting healthy diet, physical activity and weight loss for adult cancer survivors, offered by Cancer Councils (CCs) in Australia. Methods HLaC completers (n = 182) were offered extended contact via text messages for 6-months (HLaC+Txt). Text message content/frequency was individually tailored to participant’s preferences, ascertained through two telephone-tailoring interviews with CC staff. Adoption (HLaC+Txt uptake among eligible CCs), reach (uptake by HLaC completers) and implementation (intervention cost/length; text dose) were assessed. The effectiveness of extended contact relative to historic controls was quantified by pre-to-post HLaC+Txt changes in self-reported: weight, moderate-vigorous physical activity (MVPA), fruit and vegetable intake, fat and fibre behaviour. Maintenance, following 6-months of noncontact for the intervention cohort, was assessed for these same variables. Semi-structured interviews with CC staff and participants contextualised outcomes. Results HLaC+Txt was adopted by all four CCs who had delivered HLaC. In total, 115 participants commenced HLaC+Txt, with reach ranging across CCs from 47 to 80% of eligible participants. The mean number of weeks participants received the text message intervention ranged across CCs from 18.5–22.2 weeks. Participants received (median, 25th,75th percentile) 83 (48, 119) texts, ranging across CCs from 40 to 112. The total cost of HLaC+Txt delivery was on average $AUD85.00/participant. No meaningful (p < 0.05) differences in self-reported outcomes were seen between HLaC+Txt and control cohorts. After 6-months no contact the intervention cohort had maintained weight, fruit intake, fat and fibre index scores relative to end of HLaC+Txt outcomes. Participants/CC staff perceived an important intervention component was maintaining accountability. Conclusions While feasible to implement, HLaC+Txt was not effective in the short term. However, intervention effects during the non-contact period suggest the program supports longer term maintenance of weight and diet behaviour. Intervention delivery in this real-world context highlighted key considerations for future implementation. Trial registration Australian and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12615000882527 (registered on 24/08/2015).

Scale Squeeze Inhibitor as Preventive Treatment in Brani Wells, Offshore North West Java

The Brani-Field is located offshore Northwest Java and currently produces hydrocarbons from a sandstone reservoir with an average watercut of 83%. Some high watercut wells are prone to scale problems and need repetitive clean outs to overcome production decline. In 2019, downhole scale inhibitor treatment was evaluated and planned for application in these wells. Scale inhibitors are able to prevent the formation of scale so the well is able to deliver higher average oil production with lower intervention cost. In Brani wells, scale deposits are formed in perforations, downhole completion equipment, and flowlines depending on the water composition, temperature, and a reduction in dissolved carbon dioxide partial pressure. These scales deposits restrict the fluid flow causing significant production loss. In extreme conditions, the production tubing was blocked completely with the scale deposits and cease the production. Normally, the scale restriction problem in Brani wells were handled by a combination of mechanical and acidizing treatment using Coiled Tubing (CT) for downhole completion and acidizing treatment for flowline restrictions. These treatment were performed periodically every 2-4 months depending on well conditions with scaling becoming more severe in higher watercut wells. From an economic standpoint, current scale treatment methods lead to very high well intervention costs due to expensive liftboat and CT unit daily rates. The economics of these conventional treatments is further deterred by low yearly average oil production. Evaluation for scale inhibitor treatment started with the candidate selection, fluids compatibility test, core re-gain permeability test, and economic evaluation. BRG-10 well was selected as first candidate due to scale problem severity and low oil production rate. This well normally delivers 140 bopd with 90% watercut, but scale build up in the tubing and flowline prevented the fluids flow and lowered the production to 30 bopd in just two months. Laboratory test results demonstrated that the core regained permeability with the main pill fluids to a relatively high, 77.96% without any fluids compatibility issues. Deployment of a scale inhibitor squeeze treatment in BRG-10 well was executed in Jan 2020 by bullheading 657 bbl inhibitor fluids into the formation. The well was then shut in for 24 hours of soaking time. The post treatment results showed a very promising result with much more stable oil production after 11 months treatment, welltest on December 2020 showed the well was still producing 130 bopd with 90% watercut. Following the successful application in BRG-10, the scale inhibitor treatment was applied in other wells, BRK-7 in June 2020 and BRG-5L in August 2020. So far, those two wells show good production performance with 93 bopd with 85% watercut for BRK-7 and 264 bopd with 76% for BRG-5L.