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McDonald, Terrence, Brendan Lethebe, Alistair McGuire, and Lee Green. "Time modifier billing code - an interrupted time series analysis." Canadian Journal of Emergency Nursing 44, no. 2 (July 20, 2021): 17. http://dx.doi.org/10.29173/cjen137.
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Time modifier billing code: Interrupted time series analysis. Terrence McDonald, Brendan Cord Lethebe, Alistair McGuire, Lee Green Background: Alberta has the highest percentage of fee-for-service Family Physicians in Canada at over 80%. In 2019 as part of a cost containment strategy, the Alberta government proposed a policy change to eliminate the most used fee code that compensates family physicians for extended visit times (16-25 minutes). Optimal length for patient visit times varies throughout the world and countries with health systems that place emphasis on relational continuity demonstrate a trend towards longer appointment times. In Canada, the relationship between visit length and outcomes is not known. Implementation: What would be the likely consequences of eliminating the extended visit code? We examined this question using two different observational methods, to improve confidence in our findings: a retrospective longitudinal cohort (time series) around the time the code was introduced in 2009, and a cross-sectional cohort at current time. We explored the usage patterns of that fee code, its association with the outcomes of emergency department visits and hospitalizations, along with physician billings. Results: We found rates of emergency department visits decreased after the time-modifier code was implemented starting in 2010. This effect was maintained in the years that followed. A similar but less pronounced effect was observed in the hospitalization rates. The cross-sectional analysis had to include an interaction term because family physicians selectively extend visits for patients at risk, but when that is accounted for, the same effect is observed as in longitudinal results. The code was not used ubiquitously among primary care providers, especially in rural areas. Female physicians used it more often. Users use it for an average of 40% of 03.03A office visits. Non-users of the code earned more income than their user-colleagues. Conclusion: We believe our findings will fill an important gap in informing the importance of an extended time service billing code in a fee-for-service system in reducing ED visits and hospitalizations. Advice and Lessons Learned: The fee-for-service time-modifier code, introduced in 2009, resulted in reduced ED visits and hospitalizations. It is likely that discontinuing the code would result in increased ED and hospital utilization, costing much more than removing the code would save. Usage of the time-modifier code was not uniform among primary care. Users of the code had different practice patterns and provider demographics. Our next step is to model the uptake of the code by primary care providers and explore the health system utilization and down-stream costs between users and non-users of the code.
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GEBSKI, V., K. ELLINGSON, J. EDWARDS, J. JERNIGAN, and D. KLEINBAUM. "Modelling interrupted time series to evaluate prevention and control of infection in healthcare." Epidemiology and Infection 140, no. 12 (February 16, 2012): 2131–41. http://dx.doi.org/10.1017/s0950268812000179.
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SUMMARYThe most common methods for evaluating interventions to reduce the rate of new Staphylococcus aureus (MRSA) infections in hospitals use segmented regression or interrupted time-series analysis. We describe approaches to evaluating interventions introduced in different healthcare units at different times. We compare fitting a segmented Poisson regression in each hospital unit with pooling the individual estimates by inverse variance. An extension of this approach to accommodate potential heterogeneity allows estimates to be calculated from a single statistical model: a ‘stacked’ model. It can be used to ascertain whether transmission rates before the intervention have the same slope in all units, whether the immediate impact of the intervention is the same in all units, and whether transmission rates have the same slope after the intervention. The methods are illustrated by analyses of data from a study at a Veterans Affairs hospital. Both approaches yielded consistent results. Where feasible, a model adjusting for the unit effect should be fitted, or if there is heterogeneity, an analysis incorporating a random effect for units may be appropriate.
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Guan, Xiaodong, Ye Tian, Dennis Ross-Degnan, Chunxia Man, and Luwen Shi. "Interrupted time-series analysis of the impact of generic market entry of antineoplastic products in China." BMJ Open 8, no. 7 (July 2018): e022328. http://dx.doi.org/10.1136/bmjopen-2018-022328.
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ObjectivesThe rapid growth of pharmaceutical costs is a major healthcare issue all over the world. The high prices of new drugs, especially those for cancer, are also a concern for stakeholders. Generic drugs are a major price-reducing opportunity and provide more societal value. The aim of this research is to analyse the impact of generic entry on the volume and cost of antineoplastic agents in China.MethodsAn interrupted time-series design examined monthly sales of three antineoplastic drugs (capecitabine, decitabine, imatinib) from 699 public hospitals during January 2011 to June 2016. The first generic entry times (December 2013, December 2012, August 2013, respectively) were regarded as the intervention time points. We estimated changes in volume and cost following the generic entry.ResultsWe found that generic entry was associated with increases in the volume of three antineoplastic agents and decreases in their costs. In terms of volume, generic entry was associated with increases in use of capecitabine, decitabine and imatinib by 815.0 (95% CI −66.5 to 1696.5, p>0.05), 11.0 (95% CI 3.7 to 18.3, p=0.004) and 2145.5 (95% CI 1784.1 to 2506.9, p<0.001) units. The entry of generic antineoplastic drugs reduced the monthly cost trend of three agents by ¥3.1 (95% CI −¥3.6 to −¥2.6, p<0.001), ¥84.7 (95% CI −¥104.7 to −¥64.6, p<0.001) and ¥21.3 (95% CI −¥24.2 to −¥18.4, p<0.001), respectively. The entry of generic drugs attenuated the upward trend in volume of three brand-name drugs and even triggered reductions in the volume of brand-name capecitabine. The entry of generics was accompanied by significant increase of ¥2.6 in monthly brand-name decitabine cost (95% CI ¥0.2 to ¥5.1, p=0.04).ConclusionOur findings suggested that entry of generic drugs impacted use and cost of antineoplastic medicines in China. Generic drugs may improve the availability and the affordability of antineoplastic agents, which would benefit more patients.
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Holmes, John, Emma Beard, Jamie Brown, Alan Brennan, Inge Kersbergen, Petra S. Meier, Susan Michie, Abigail K. Stevely, and Penny Buykx. "The impact of promoting revised UK low-risk drinking guidelines on alcohol consumption: interrupted time series analysis." Public Health Research 8, no. 14 (October 2020): 1–108. http://dx.doi.org/10.3310/phr08140.
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Background The UK’s Chief Medical Officers revised the UK alcohol drinking guidelines in 2016 to ≤ 14 units per week (1 unit = 10 ml/8 g ethanol) for men and women. Previously, the guideline stated that men should not regularly consume more than 3–4 units per day and women should not regularly consume more than 2–3 units per day. Objective To evaluate the impact of promoting revised UK drinking guidelines on alcohol consumption. Design Interrupted time series analysis of observational data. Setting England, March 2014 to October 2017. Participants A total of 74,388 adults aged ≥ 16 years living in private households in England. Interventions Promotion of revised UK low-risk drinking guidelines. Main outcome measures Primary outcome – alcohol consumption measured by the Alcohol Use Disorders Identification Test – Consumption score. Secondary outcomes – average weekly consumption measured using graduated frequency, monthly alcohol consumption per capita adult (aged ≥ 16 years) derived from taxation data, monthly number of hospitalisations for alcohol poisoning (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision: T51.0, T51.1 and T51.9) and assault (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision: X85–Y09), and further measures of influences on behaviour change. Data sources The Alcohol Toolkit Study, a monthly cross-sectional survey and NHS Digital’s Hospital Episode Statistics. Results The revised drinking guidelines were not subject to large-scale promotion after the initial January 2016 announcement. An analysis of news reports found that mentions of the guidelines were mostly factual, and spiked during January 2016. In December 2015, the modelled average Alcohol Use Disorders Identification Test – Consumption score was 2.719 out of 12.000 and was decreasing by 0.003 each month. After the January 2016 announcement, Alcohol Use Disorders Identification Test – Consumption scores did not decrease significantly (β = 0.001, 95% confidence interval –0.079 to 0.099). However, the trend did change significantly such that scores subsequently increased by 0.005 each month (β = 0.008, 95% confidence interval 0.001 to 0.015). This change is equivalent to 0.5% of the population moving each month from drinking two or three times per week to drinking four or more times per week. Secondary analyses indicated that the change in trend began 6 months before the guideline announcement. The secondary outcome measures showed conflicting results, with no significant changes in consumption measures and no substantial changes in influences on behaviour change, but immediate reductions in hospitalisations of 7.3% for assaults and 15.4% for alcohol poisonings. Limitations The pre-intervention data collection period was only 2 months for influences on behaviour change and the graduated frequency measure. Our conclusions may be generalisable only to scenarios in which guidelines are announced but not promoted. Conclusions The announcement of revised UK low-risk drinking guidelines was not associated with clearly detectable changes in drinking behaviour. Observed reductions in alcohol-related hospitalisations are unlikely to be attributable to the revised guidelines. Promotion of the guidelines may have been prevented by opposition to the revised guidelines from the government's alcohol industry partners or because reduction in alcohol consumption was not a government priority or because practical obstacles prevented independent public health organisations from promoting the guidelines. Additional barriers to the effectiveness of guidelines may include low public understanding and a need for guidelines to engage more with how drinkers respond to and use them in practice. Trial registration Current Controlled Trials ISRCTN15189062. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 14. See the NIHR Journals Library website for further project information.
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Tao, Liyuan, Chen Zhang, Lin Zeng, Shengrong Zhu, Nan Li, Wei Li, Hua Zhang, Yiming Zhao, Siyan Zhan, and Hong Ji. "Accuracy and Effects of Clinical Decision Support Systems Integrated With BMJ Best Practice–Aided Diagnosis: Interrupted Time Series Study." JMIR Medical Informatics 8, no. 1 (January 20, 2020): e16912. http://dx.doi.org/10.2196/16912.
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Background Clinical decision support systems (CDSS) are an integral component of health information technologies and can assist disease interpretation, diagnosis, treatment, and prognosis. However, the utility of CDSS in the clinic remains controversial. Objective The aim is to assess the effects of CDSS integrated with British Medical Journal (BMJ) Best Practice–aided diagnosis in real-world research. Methods This was a retrospective, longitudinal observational study using routinely collected clinical diagnosis data from electronic medical records. A total of 34,113 hospitalized patient records were successively selected from December 2016 to February 2019 in six clinical departments. The diagnostic accuracy of the CDSS was verified before its implementation. A self-controlled comparison was then applied to detect the effects of CDSS implementation. Multivariable logistic regression and single-group interrupted time series analysis were used to explore the effects of CDSS. The sensitivity analysis was conducted using the subgroup data from January 2018 to February 2019. Results The total accuracy rates of the recommended diagnosis from CDSS were 75.46% in the first-rank diagnosis, 83.94% in the top-2 diagnosis, and 87.53% in the top-3 diagnosis in the data before CDSS implementation. Higher consistency was observed between admission and discharge diagnoses, shorter confirmed diagnosis times, and shorter hospitalization days after the CDSS implementation (all P<.001). Multivariable logistic regression analysis showed that the consistency rates after CDSS implementation (OR 1.078, 95% CI 1.015-1.144) and the proportion of hospitalization time 7 days or less (OR 1.688, 95% CI 1.592-1.789) both increased. The interrupted time series analysis showed that the consistency rates significantly increased by 6.722% (95% CI 2.433%-11.012%, P=.002) after CDSS implementation. The proportion of hospitalization time 7 days or less significantly increased by 7.837% (95% CI 1.798%-13.876%, P=.01). Similar results were obtained in the subgroup analysis. Conclusions The CDSS integrated with BMJ Best Practice improved the accuracy of clinicians’ diagnoses. Shorter confirmed diagnosis times and hospitalization days were also found to be associated with CDSS implementation in retrospective real-world studies. These findings highlight the utility of artificial intelligence-based CDSS to improve diagnosis efficiency, but these results require confirmation in future randomized controlled trials.
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Knowles, Emma, Neil Shephard, Tony Stone, Lindsey Bishop-Edwards, Enid Hirst, Linda Abouzeid, Suzanne Mason, and Jon Nicholl. "Closing five Emergency Departments in England between 2009 and 2011: the closED controlled interrupted time-series analysis." Health Services and Delivery Research 6, no. 27 (July 2018): 1–234. http://dx.doi.org/10.3310/hsdr06270.
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BackgroundIn recent years, a number of emergency departments (EDs) have closed or have been replaced by another facility such as an urgent care centre. With further reorganisation of EDs expected, this study aimed to provide research evidence to inform the public, the NHS and policy-makers when considering local closures.ObjectiveTo understand the impact of ED closures/downgrades on populations and emergency care providers.DesignA controlled interrupted time series of monthly data to assess changes in the patterns of mortality in local populations and changes in local emergency care service activity and performance, following the closure of type 1 EDs.SettingThe populations of interest were in the resident catchment areas of five EDs that closed between 2009 and 2011 (in Newark, Hemel Hempstead, Bishop Auckland, Hartlepool and Rochdale) and of five control areas.Main outcome measuresThe primary outcome measures were ambulance service incident volumes and times, the number of emergency and urgent care attendances at EDs, the number of emergency hospital admissions, mortality, and case fatality ratios.Data sourcesData were sourced from the Office for National Statistics, Hospital Episode Statistics (HES) accident and emergency, HES admitted patient care and ambulance service computer-aided dispatch records.ResultsThere was significant heterogeneity among sites in the results for most of the outcome measures, but the overall findings were as follows: there is evidence of an increase, on average, in the total number of incidents attended by an ambulance following 999 calls, and those categorised as potentially serious emergency incidents; there is no statistically reliable evidence of changes in the number of attendances at emergency or urgent care services or emergency hospital admissions; there is no statistically reliable evidence of any change in the number of deaths from a set of emergency conditions following the ED closure in any site, although, on average, there was a small increase in an indicator of the ‘risk of death’ in the closure areas compared with the control areas.LimitationsUnavailable or unreliable data hindered some of the analysis regarding ED and ambulance service performance.ConclusionsOverall, across the five areas studied, there was no statistically reliable evidence that the reorganisation of emergency care was associated with an increase in population mortality. This suggests that any negative effects caused by increased journey time to the ED can be offset by other factors; for example, if other new services are introduced and care becomes more effective than it used to be, or if the care received at the now-nearest hospital is more effective than that provided at the hospital where the ED closed. However, there may be implications of reorganisation for NHS emergency care providers, with ambulance services appearing to experience a greater burden.Future workUnderstanding why effects vary between sites is necessary. It is also necessary to understand the impact on patient experience. Economic evaluation to understand the cost implications of such reorganisation is also desirable.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Innes, G., J. Marsden, D. Kalla, R. Stenstrom, and E. Grafstein. "MP017: Impact of physician payment mechanism on wait times and ED length of stay." CJEM 18, S1 (May 2016): S72. http://dx.doi.org/10.1017/cem.2016.158.
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Introduction: Vancouver Coastal Health (VCH) emergency physicians have been on contract based funding models for two decades. On October 1, 2015, physicians at one hospital (SPH) switched to fee-for-service (FFS) payments. Conventional wisdom is that FFS physicians are motivated to see more patients quickly and achieve higher throughput. Our hypothesis was that FFS payment would reduce patient wait times. Methods: This interrupted time series analysis with concurrent control was performed in VCH Region, where there are two tertiary EDs. During the 20-week study period (July 15-Nov 30), VGH remained on contract, while SPH converted to FFS (the intervention). VCH administrative data was aggregated by week. Our primary outcome was median wait time to MD. Secondary outcomes were ED LOS and left-without-being-seen (LWBS) rates. Results: Interrupted time series plots will be presented for the data. Data from 67,214 ED visits were analyzed (31,733 SPH, 35,481 VGH). Figure 1 shows that baseline wait time was 74 minutes at the control and 53 minutes at the intervention site. During the pre-intervention period, there was a non-significant downward trend of 0.4 minutes per week at the intervention hospital relative to control (p=0.26). After FFS conversion, there was a 4.1 minute increase in wait time at the control site (p=0.18), and a significant downward trend of 1.4 minutes per week (p=0.001). After FFS conversion, wait times at the intervention site increased by 4.8 minutes more than control (p-value for the difference=0.27), and the wait time trend increased significantly by 1.3 minutes per week relative to the expected counterfactual trend (p=0.02). Baseline EDLOS for discharged patients was 227 minutes at the control hospital and 193 minutes at the intervention site. There were similar pre-intervention LOS increases at both hospitals. Post-intervention, both sites saw significant increases in EDLOS, followed by a similar downward trends of -2.68 minutes per week (p=0.001). Baseline LWBS rate was 3.86% at the control hospital and 3.56% at the intervention site. Pre-intervention trends, and post-intervention level/trend changes did not differ by site. Conclusion: Conversion to FFS payment was associated with an increase in wait time trend of 1.3 minutes per week relative to control. There were no significant changes in EDLOS or LWBS rates. In this preliminary analysis, FFS payment had little effect on wait times or patient throughput.
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Evdokimova, Ekaterina, Sabine Wittevrongel, and Dieter Fiems. "A Taylor Series Approach for Service-Coupled Queueing Systems with Intermediate Load." Mathematical Problems in Engineering 2017 (2017): 1–10. http://dx.doi.org/10.1155/2017/3298605.
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This paper investigates the performance of a queueing model with multiple finite queues and a single server. Departures from the queues are synchronised or coupled which means that a service completion leads to a departure in every queue and that service is temporarily interrupted whenever any of the queues is empty. We focus on the numerical analysis of this queueing model in a Markovian setting: the arrivals in the different queues constitute Poisson processes and the service times are exponentially distributed. Taking into account the state space explosion problem associated with multidimensional Markov processes, we calculate the terms in the series expansion in the service rate of the stationary distribution of the Markov chain as well as various performance measures when the system is (i) overloaded and (ii) under intermediate load. Our numerical results reveal that, by calculating the series expansions of performance measures around a few service rates, we get accurate estimates of various performance measures once the load is above 40% to 50%.
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Harada, Yukinori, and Taro Shimizu. "Impact of a Commercial Artificial Intelligence–Driven Patient Self-Assessment Solution on Waiting Times at General Internal Medicine Outpatient Departments: Retrospective Study." JMIR Medical Informatics 8, no. 8 (August 31, 2020): e21056. http://dx.doi.org/10.2196/21056.
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Background Patient waiting time at outpatient departments is directly related to patient satisfaction and quality of care, particularly in patients visiting the general internal medicine outpatient departments for the first time. Moreover, reducing wait time from arrival in the clinic to the initiation of an examination is key to reducing patients’ anxiety. The use of automated medical history–taking systems in general internal medicine outpatient departments is a promising strategy to reduce waiting times. Recently, Ubie Inc in Japan developed AI Monshin, an artificial intelligence–based, automated medical history–taking system for general internal medicine outpatient departments. Objective We hypothesized that replacing the use of handwritten self-administered questionnaires with the use of AI Monshin would reduce waiting times in general internal medicine outpatient departments. Therefore, we conducted this study to examine whether the use of AI Monshin reduced patient waiting times. Methods We retrospectively analyzed the waiting times of patients visiting the general internal medicine outpatient department at a Japanese community hospital without an appointment from April 2017 to April 2020. AI Monshin was implemented in April 2019. We compared the median waiting time before and after implementation by conducting an interrupted time-series analysis of the median waiting time per month. We also conducted supplementary analyses to explain the main results. Results We analyzed 21,615 visits. The median waiting time after AI Monshin implementation (74.4 minutes, IQR 57.1) was not significantly different from that before AI Monshin implementation (74.3 minutes, IQR 63.7) (P=.12). In the interrupted time-series analysis, the underlying linear time trend (–0.4 minutes per month; P=.06; 95% CI –0.9 to 0.02), level change (40.6 minutes; P=.09; 95% CI –5.8 to 87.0), and slope change (–1.1 minutes per month; P=.16; 95% CI –2.7 to 0.4) were not statistically significant. In a supplemental analysis of data from 9054 of 21,615 visits (41.9%), the median examination time after AI Monshin implementation (6.0 minutes, IQR 5.2) was slightly but significantly longer than that before AI Monshin implementation (5.7 minutes, IQR 5.0) (P=.003). Conclusions The implementation of an artificial intelligence–based, automated medical history–taking system did not reduce waiting time for patients visiting the general internal medicine outpatient department without an appointment, and there was a slight increase in the examination time after implementation; however, the system may have enhanced the quality of care by supporting the optimization of staff assignments.
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Leopold, Christine, Fang Zhang, Aukje K. Mantel-Teeuwisse, Sabine Vogler, Silvia Valkova, Dennis Ross-Degnan, and Anita K. Wagner. "Impact of pharmaceutical policy interventions on utilization of antipsychotic medicines in Finland and Portugal in times of economic recession: interrupted time series analyses." International Journal for Equity in Health 13, no. 1 (2014): 53. http://dx.doi.org/10.1186/1475-9276-13-53.
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Cho, Jungwon, Young Suk Park, Do Joong Park, Soyeon Kim, Haekyung Lee, Minjeong Kim, Eunsook Lee, Ho-Young Lee, and Euni Lee. "Bridging Policy and Service Performance of Hospital-Based Nutrition Support by Healthcare Information Technology." Nutrients 13, no. 2 (February 11, 2021): 595. http://dx.doi.org/10.3390/nu13020595.
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Although the healthcare policy was implemented to incentivize the multidisciplinary services of hospital-based nutrition support team (NST) in South Korea, timely completion of the services has been challenging in the hospitals. We enhanced NST healthcare information technology (NST−HIT) to bridge the gap between policy implementation and seamless execution of the policy in the hospital system. A 48 month pre-test−post-test study was performed, including a 12 month pre-intervention period, a six month intervention period, and a 30 month post-intervention period. The enhanced NST−HIT provided sufficient patient data and streamlined communication processes among end-users. A Student’s t-test showed that the timely completion rate of NST consultations, the reimbursement rate of NST consultations, average response times of NST physicians and nurses, and length of hospital stay significantly improved during the post-intervention period. A segmented regression analysis of interrupted time series showed that the average response times of NST physicians had sustained after the interventions. We believe that well-structured, multi-pronged initiatives with leadership support from the hospital improved service performance of hospital NST in response to national-level healthcare policy changes.
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Stocks, S. J., R. McNamee, S. Turner, M. Carder, and R. M. Agius. "The impact of national‐level interventions to improve hygiene on the incidence of irritant contact dermatitis in healthcare workers: changes in incidence from 1996 to 2012 and interrupted times series analysis." British Journal of Dermatology 173, no. 1 (June 2, 2015): 165–71. http://dx.doi.org/10.1111/bjd.13719.
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Gohil, Shruti K., Jennifer Yim, Kathleen Quan, Maurice Espinoza, Deborah J. Thompson, Allen P. Kong, Bardia Bahadori, et al. "Impact of a Central-Line Insertion Site Assessment (CLISA) score on localized insertion site infection to prevent central-line–associated bloodstream infection (CLABSI)." Infection Control & Hospital Epidemiology 41, no. 1 (November 8, 2019): 59–66. http://dx.doi.org/10.1017/ice.2019.291.
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AbstractObjective:To assess the impact of a newly developed Central-Line Insertion Site Assessment (CLISA) score on the incidence of local inflammation or infection for CLABSI prevention.Design:A pre- and postintervention, quasi-experimental quality improvement study.Setting and participants:Adult inpatients with central venous catheters (CVCs) hospitalized in an intensive care unit or oncology ward at a large academic medical center.Methods:We evaluated CLISA score impact on insertion site inflammation and infection (CLISA score of 2 or 3) incidence in the baseline period (June 2014–January 2015) and the intervention period (April 2015–October 2017) using interrupted times series and generalized linear mixed-effects multivariable analyses. These were run separately for days-to-line removal from identification of a CLISA score of 2 or 3. CLISA score interrater reliability and photo quiz results were evaluated.Results:Among 6,957 CVCs assessed 40,846 times, percentage of lines with CLISA score of 2 or 3 in the baseline and intervention periods decreased by 78.2% (from 22.0% to 4.7%), with a significant immediate decrease in the time-series analysis (P < .001). According to the multivariable regression, the intervention was associated with lower percentage of lines with a CLISA score of 2 or 3, after adjusting for age, gender, CVC body location, and hospital unit (odds ratio, 0.15; 95% confidence interval, 0.06–0.34; P < .001). According to the multivariate regression, days to removal of lines with CLISA score of 2 or 3 was 3.19 days faster after the intervention (P < .001). Also, line dwell time decreased 37.1% from a mean of 14 days (standard deviation [SD], 10.6) to 8.8 days (SD, 9.0) (P < .001). Device utilization ratios decreased 9% from 0.64 (SD, 0.08) to 0.58 (SD, 0.06) (P = .039).Conclusions:The CLISA score creates a common language for assessing line infection risk and successfully promotes high compliance with best practices in timely line removal.
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Penn, Marion L., Thomas Monks, Catherine Pope, and Mike Clancy. "A mixed methods study of the impact of consultant overnight working in an English Emergency Department." Emergency Medicine Journal 36, no. 5 (August 9, 2018): 298–302. http://dx.doi.org/10.1136/emermed-2018-207571.
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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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Schrank, Gregory M., Graham M. Snyder, Roger B. Davis, Westyn Branch-Elliman, and Sharon B. Wright. "The discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus: Impact upon patient adverse events and hospital operations." BMJ Quality & Safety 29, no. 10 (July 18, 2019): 1.1–2. http://dx.doi.org/10.1136/bmjqs-2018-008926.
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BackgroundContact precautions for endemic methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) are a resource-intensive intervention to reduce healthcare-associated infections, potentially impeding patient throughput and limiting bed availability to isolate other contagious pathogens. We investigated the impact of the discontinuation of contact precautions (DcCP) for endemic MRSA and VRE on patient outcomes and operations metrics in an acute care setting.MethodsThis is a retrospective, quasi-experimental analysis of the 12 months before and after DcCP for MRSA and VRE at an academic medical centre. The frequency for bed closures due to contact isolation was measured, and personal protective equipment (PPE) expenditures and patient satisfaction survey results were compared using the Wilcoxon signed-rank test. Using an interrupted time series design, emergency department (ED) admission wait times and rates of patient falls, pressure ulcers and nosocomial MRSA and VRE clinical isolates were compared using GEEs.ResultsPrior to DcCP, bed closures for MRSA and/or VRE isolation were associated with estimated lost hospital charges of $9383 per 100 bed days (95% CI: 8447 to 10 318). No change in ED wait times or change in trend was observed following DcCP. There were significant reductions in monthly expenditures on gowns (−61.0%) and gloves (−16.3%). Patient satisfaction survey results remained stable. No significant changes in rates or trends were observed for patient falls or pressure ulcers. Incidence rates of nosocomial MRSA (1.58 (95% CI: 0.82 to 3.04)) and VRE (1.02 (95% CI: 0.82 to 1.27)) did not significantly change.ConclusionsDcCP was associated with an increase in bed availability and revenue recovery, and a reduction in PPE expenditures. Benefits for other hospital operations metrics and patient outcomes were not identified.
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Lyerla, Frank, Cynthia LeRouge, Dorothy A. Cooke, Debra Turpin, and Lisa Wilson. "A Nursing Clinical Decision Support System and Potential Predictors of Head-of-Bed Position for Patients Receiving Mechanical Ventilation." American Journal of Critical Care 19, no. 1 (January 1, 2010): 39–47. http://dx.doi.org/10.4037/ajcc2010836.
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Background Patients receiving mechanical ventilation are at high risk for pneumonia due to aspiration. Published guidelines recommend elevating the head of the bed 30° to 45°, if not contraindicated, to reduce risk, but this intervention is underused.Objectives To facilitate incorporating evidence-based practice by improving positioning of patients receiving mechanical ventilation and to identify patient and nurse characteristics that predict use of the guideline.Methods A modified interrupted time-series design was used. Data were collected on 43 patients and 33 nurses 3 separate times in a 12-bed intensive care unit at a medium-sized hospital. A total of 105 observations were recorded for analysis each time.Results Mean elevations of the head of the bed increased significantly from phase 1 (27.7°) to phase 2 (31.7°) and from phase 1 to phase 3 (31.1°). Elevations were higher for tube-fed patients than for patients not given enteral tube feedings. Elevations were higher for patients with a pulmonary-related diagnosis and lower for patients with a gastrointestinal diagnosis than for patients with other diagnoses. Elevations were lower for patients with a body mass index between 25.0 and 29.9 (overweight) than for patients with other body mass index values. Nurse characteristics were not significant predictors of elevation.Conclusion A nursing clinical decision support system integrated into a patient’s electronic flow sheet can increase nurses’ adherence to guidelines. Pulmonary and gastrointestinal diagnoses, body mass index, and tube feeding are predictors of elevation of the head of the bed.
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Mitchell, Renée J., Barak Ariel, Maria Emilia Firpo, Ricardo Fraiman, Federico del Castillo, Jordan M. Hyatt, Cristobal Weinborn, and Hagit Brants Sabo. "Measuring the effect of body-worn cameras on complaints in Latin America." Policing: An International Journal 41, no. 4 (August 13, 2018): 510–24. http://dx.doi.org/10.1108/pijpsm-01-2018-0004.
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Purpose More than a half a dozen published studies have observed the effect of body-worn cameras (BWCs) on complaints against the police. Nearly all, with varying degrees of methodological sophistication, tell a similar story: a strong reduction in complaints filed against the police once BWCs are in use. However, the entirety of the published evidence comes from English speaking countries, limited to the USA and the UK, and is restricted to the effects of BWCs on response policing. The purpose of this paper is to extend this body of research to Latin America, and to specialized policing jobs. Design/methodology/approach The authors measured the consequence of equipping traffic police officers with BWCs in five out of the 19 traffic police departments in Uruguay (n=208), and compared these settings to both the pre-test figures as well as to the non-treatment departments. Interrupted time-series analyses and repeated measures of analysis were used for significance testing. Findings Statistically significant differences emerged between the before–after as well as the between–groups comparisons: complaints were five times higher in the comparison vs the treatment jurisdictions, and there were 86 percent fewer cases compared to the pre-treatment period. Research limitations/implications These outcomes suggest that the effect of BWCs on complaints is ubiquitous. Practical implications The findings indicate that BWCs provide an effective solution for reducing grievances against the police, which can potentially be a marker of increased accountability, transparency and legitimacy for the Latin American law enforcement departments. Originality/value This study is an extension of findings on BWCs to non-English-speaking police departments, with a focus on specialized policing rather than patrol policing.
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Knowles, Emma, Neil Shephard, Tony Stone, Suzanne M. Mason, and Jon Nicholl. "The impact of closing emergency departments on mortality in emergencies: an observational study." Emergency Medicine Journal 36, no. 11 (October 7, 2019): 645–51. http://dx.doi.org/10.1136/emermed-2018-208146.
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BackgroundIn England the demand for emergency care is increasing, while there is also a staffing shortage. This has implications for quality of care and patient safety. One solution may be to concentrate resources on fewer sites by closing or downgrading emergency departments (EDs). Our aim was to quantify the impact of such reorganisation on population mortality.MethodsWe undertook a controlled interrupted time series analysis to detect the impact of closing or downgrading five EDs, which occurred due to concerns regarding sustainability. We obtained mortality data from 2007 to 2014 using national databases. To establish ED resident catchment populations, estimated journey times by road were supplied by the Department for Transport. Other major changes in the emergency and urgent care system were determined by analysis of annual NHS Trust reports in each geographical area studied. Our main outcome measures were mortality and case fatality for a set of 16 serious emergency conditions.ResultsFor residents in the areas affected by closure, journey time to the nearest ED increased (median change 9 min, range 0–25 min). We found no statistically reliable evidence of a change in overall mortality following reorganisation of ED care in any of the five areas or overall (+2.5% more deaths per month on average; 95% CI −5.2% to +10.2%; p=0.52). There was some evidence to suggest that, on average across the five areas, there was a small increase in case fatality, an indicator of the ‘risk of death’ (+2.3%, 95% CI +0.9% to+3.6%; p<0.001), but this may have arisen due to changes in hospital admissions.ConclusionsWe found no evidence that reorganisation of emergency care was associated with a change in population mortality in the five areas studied. Further research should establish the economic consequences and impact on patient experience and neighbouring hospitals.
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Woods, Diana Lynn, and Margaret Dimond. "The Effect of Therapeutic Touch on Agitated Behavior and Cortisol in Persons with Alzheimer’s Disease." Biological Research For Nursing 4, no. 2 (October 2002): 104–14. http://dx.doi.org/10.1177/1099800402238331.
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Agitated behavior in persons with Alzheimer’s disease (AD) presents a challenge to current interventions. Recent developments in neuroendocrinology suggest that changes in the hypothalamic-pituitaryadrenal (HPA) axis alter the responses of persons with AD to stress. Given the deleterious effects of pharmacological interventions in this vulnerable population, it is essential to explore noninvasive treatments for their potential to decrease a hyperresponsiveness to stress and indirectly decrease detrimental cortisol levels. This within-subject, interrupted time-series study was conducted to test the efficacy of therapeutic touch on decreasing the frequency of agitated behavior and salivary and urine cortisol levels in persons with AD. Ten subjects who were 71 to 84 years old and resided in a special care unit were observed every 20 minutes for 10 hours a day, were monitored 24 hours a day for physical activity, and had samples for salivary and urine cortisol taken daily. The study occurred in 4 phases: 1) baseline (4 days), 2) treatment (therapeutic touch for 5 to 7 minutes 2 times a day for 3 days), 3) posttreatment (11 days), and 4) post-“wash-out” (3 days). An analysis of variance for repeated measures indicated a significant decrease in overall agitated behavior and in 2 specific behaviors, vocalization and pacing or walking, during treatment and posttreatment. A decreasing trend over time was noted for salivary and urine cortisol. Although this study does not provide direct clinical evidence to support dysregulation in the HPA axis, it does suggest that environmental and behavioral interventions such as therapeutic touch have the potential to decrease vocalization and pacing, 2 prevalent behaviors, and may mitigate cortisol levels in persons with AD.
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Hogan, Helen, Andrew Hutchings, Jerome Wulff, Catherine Carver, Elizabeth Holdsworth, John Welch, David Harrison, and Nick Black. "Interventions to reduce mortality from in-hospital cardiac arrest: a mixed-methods study." Health Services and Delivery Research 7, no. 2 (January 2019): 1–110. http://dx.doi.org/10.3310/hsdr07020.
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BackgroundUnchecked patient deterioration can lead to in-hospital cardiac arrest (IHCA) and avoidable death. The National Cardiac Arrest Audit (NCAA) has found fourfold variation in IHCA rates and survival between English hospitals. Key to reducing IHCA is both the identification of patients at risk of deterioration and prompt response. A range of targeted interventions have been introduced but implementation varies between hospitals. These differences are likely to contribute to the observed variation between and within hospitals over time.ObjectiveTo determine how interventions aimed at identification and management of deteriorating patients are associated with IHCA rates and outcomes.DesignA mixed-methods study involving a systematic literature review, semistructured interviews with 60 NHS staff, an organisational survey in 171 hospitals and interrupted time series and difference-in-difference analyses (106 hospitals).SettingEnglish hospitals participating in the NCAA audit.ParticipantsNHS staff (approximately 300) and patients (13 million).InterventionsEducation, track-and-trigger systems (TTSs), standardised handover tools and outreach teams.Main outcome measuresIHCA rates, survival and hospital-wide mortality.Data sourcesNCAA, Hospital Episode Statistics, Office for National Statistics Mortality Statistics.MethodsA literature review and qualitative interviews were used to design an organisational survey that determined how interventions have been implemented in practice and across time. Associations between variations in services and IHCA rates and survival were determined using cross-sectional, interrupted time series and difference-in-difference analyses over the index study period (2009/10 to 2014/15).ResultsAcross NCAA hospitals, IHCAs fell by 6.4% per year and survival increased by 5% per year, with hospital mortality decreasing by a similar amount. A national, standard TTS [the National Early Warning Score (NEWS)], introduced in 2012, was adopted by 70% of hospitals by 2015. By 2015, one-third of hospitals had converted from paper-based TTSs to electronic TTSs, and there had been an increase in the number of hospitals with an outreach team and an increase in the number with a team available at all times. The extent of variation in the uses of educational courses and structured handover tools was limited, with 90% of hospitals reporting use of standardised communication tools, such as situation, background, assessment and recommendation, in 2015. Introduction of the NEWS was associated with an additional 8.4% decrease in IHCA rates and, separately, a conversion from paper to electronic TTS use was associated with an additional 7.6% decrease. However, there was no associated change in IHCA survival or hospital mortality. Outreach teams were not associated with a change in IHCA rates, survival or hospital mortality. A sensitivity analysis restricted to ward-based IHCAs did not alter the findings but did identify an association between increased outreach team intensity in 2015 and IHCA survival.LimitationsThe organisational survey was not able to explore all aspects of the interventions and the contextual factors that influenced them. Changes over time were dependent on respondents’ recall.ConclusionsStandardisation of TTSs and introduction of electronic TTSs are associated with a reduction in IHCAs. The apparent lack of impact of outreach teams may reflect their mode of introduction, that their effect is through providing support for implementation of TTS or that the organisation of the response to deterioration is not critical, as long as it is timely. Their role in end-of-life decision-making may account for the observed association with IHCA survival.Future workTo assess the potential impact of outreach teams at hospital level and patient level, and to establish which component of the TTS has the greatest effect on outcomes.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Botan, Vanessa, Graham R. Law, Despina Laparidou, Elise Rowan, Murray D. Smith, Colin Ridyard, Amanda Brewster, et al. "01 The effects of a leaflet-based intervention, ‘hypos can strike twice’, on recurrent hypoglycaemic attendances by ambulance services: a non-randomised stepped wedge study." Emergency Medicine Journal 38, no. 9 (August 19, 2021): A1.1—A1. http://dx.doi.org/10.1136/emermed-2021-999.1.
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BackgroundHypoglycaemia is a common complication of diabetes therapy needing prompt recognition and treatment. It often results in ambulance attendance incurring health services costs and patient morbidity. Patient education is important for maintaining glycaemic control and preventing recurrent hypoglycaemia. We aimed to investigate the effect of an intervention in which ambulance staff were trained to provide advice supported by a booklet – ‘Hypos can strike twice’- issued following a hypoglycaemic event to prevent future attendances.MethodsWe used a non-randomised stepped wedge-controlled design. The intervention was introduced at different times (steps) in different areas (clusters) of operation of East Midlands Ambulance Service NHS Trust (EMAS). During the first step (T0) no clusters were exposed to the intervention and during the last step (T3) all clusters were exposed. The main outcome was the number of unsuccessful ambulance attendances (i.e. attendances followed by a repeat attendance). Data were analysed using a general linear mixed model (GLMM) and an interrupted-time series analysis (ITSA).ResultsThe study included 4825 patients (mean age= 65.42, SD=19.42; 2166 females) experiencing hypoglycaemic events attended by EMAS. GLMM indicated a reduction in the number of unsuccessful attendances in the final step of the intervention when compared to the first (OR: 0.50, 95%CI: 0.33-0.76, p=0.001). ITSA indicated a significant decrease in repeat ambulance attendances for hypoglycaemia – relative to the pre-intervention trend (p=0.008). The hypoglycaemia care bundle (i.e. blood glucose recorded before and after treatment for hypoglycaemia) was delivered in 66% of attendances during the intervention period, demonstrating a significant level of practice change (χ2=30.16, p<0.001).ConclusionsThe ‘Hypos can strike twice’ intervention had a positive effect on reducing numbers of repeat attendances for hypoglycaemia and in achieving the care bundle. The study supports the use of informative booklets by ambulance clinicians to prevent future attendances for recurrent hypoglycaemic events.
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Trease, Larissa, Kellie Wilkie, Greg Lovell, Michael Drew, and Ivan Hooper. "Epidemiology of injury and illness in 153 Australian international-level rowers over eight international seasons." British Journal of Sports Medicine 54, no. 21 (June 25, 2020): 1288–93. http://dx.doi.org/10.1136/bjsports-2019-101402.
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AimTo report the epidemiology of injury and illness in elite rowers over eight seasons (two Olympiads).MethodsAll athletes selected to the Australian Rowing Team between 2009 and 2016 were monitored prospectively under surveillance for injury and illness. The incidence and burden of injury and illness were calculated per 1000 athlete days (ADs). The body area, mechanism and type of all injuries were recorded and followed until the resumption of full training. We used interrupted time series analyses to examine the association between fixed and dynamic ergometer testing on rowers’ injury rates. Time lost from illness was also recorded.ResultsAll 153 rowers selected over eight seasons were observed for 48 611 AD. 270 injuries occurred with an incidence of 4.1–6.4 injuries per 1000 AD. Training days lost totalled 4522 (9.2% AD). The most frequent area injured was the lumbar region (84 cases, 1.7% AD) but the greatest burden was from chest wall injuries (64 cases, 2.6% AD.) Overuse injuries (n=224, 83%) were more frequent than acute injuries (n=42, 15%). The most common activity at the time of injury was on-water rowing training (n=191, 68). Female rowers were at 1.4 times the relative risk of chest wall injuries than male rowers; they had half the relative risk of lumbar injuries of male rowers. The implementation of a dynamic ergometers testing policy (Concept II on sliders) was positively associated with a lower incidence and burden of low back injury compared with fixed ergometers (Concept II). Illness accounted for the greatest number of case presentations (128, 32.2% cases, 1.2% AD).ConclusionsChest wall and lumbar injuries caused training time loss. Policy decisions regarding ergometer testing modality were associated with lumbar injury rates. As in many sports, illness burden has been under-recognised in elite Australian rowers.
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Matowe, Lloyd K., Cathie A. Leister, Concetta Crivera, and Joan M. Korth-Bradley. "Interrupted Time Series Analysis in Clinical Research." Annals of Pharmacotherapy 37, no. 7-8 (July 2003): 1110–16. http://dx.doi.org/10.1345/aph.1a109.
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OBJECTIVE: To demonstrate the usefulness of interrupted time series analysis in clinical trial design. METHODS: A safety data set of electrocardiographic (ECG) information was simulated from actual data that had been collected in a Phase I study. Simulated data on 18 healthy volunteers based on a study performed in a contract research facility were collected based on single doses of an experimental medication that may affect ECG parameters. Serial ECGs were collected before and during treatment with the experimental medication. Data from 7 real subjects receiving placebo were used to simulate the pretreatment phase of time series; data from 18 real subjects receiving active treatment were used to simulate the treatment phase of the time series. Visual inspection of data was performed, followed by tests for trend, seasonality, and autocorrelation by use of SAS. RESULTS: There was no evidence of trend, seasonality, or autocorrelation. In 11 of 18 simulated individuals, statistically significant changes in QTc intervals were observed following treatment with the experimental medication. A significant time of day and treatment interaction was observed in 4 simulated patients. CONCLUSIONS: Interrupted time series analysis techniques offer an additional tool for the study of clinical situations in which patients must act as their own controls and where serial data can be collected at evenly distributed intervals.
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Crosbie, John, and Christopher F. Sharpley. "DMITSA: A simplified interrupted time-series analysis program." Behavior Research Methods, Instruments, & Computers 21, no. 6 (November 1989): 639–42. http://dx.doi.org/10.3758/bf03210591.
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Wong, Ricky H., Fabrice Smieliauskas, I.-Wen Pan, and Sandi K. Lam. "Interrupted time-series analysis: studying trends in neurosurgery." Neurosurgical Focus 39, no. 6 (December 2015): E6. http://dx.doi.org/10.3171/2015.9.focus15374.
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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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Anderton, Charles H., and John R. Carter. "The Impact of War on Trade: An Interrupted Times-Series Study." Journal of Peace Research 38, no. 4 (July 2001): 445–57. http://dx.doi.org/10.1177/0022343301038004003.
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Cabrero, Monica, Elias Jabbour, Naval Daver, Gautam Borthakur, Courtney D. DiNardo, Jorge E. Cortes, Zach Bohannan, et al. "Discontinuation of HMA Therapy after Achieving Complete or Partial Response: Retrospective Analysis of Survival after Long-Term Follow up." Blood 124, no. 21 (December 6, 2014): 4664. http://dx.doi.org/10.1182/blood.v124.21.4664.4664.
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Abstract Introduction: Hypomethylating agents (HMA), such as decitabine or 5-azacitidine, are the first-line treatment for higher-risk myelodysplastic syndromes (MDS) and are commonly used in refractory or elderly acute myeloid leukemia (AML) patients. There is anecdotal evidence that early discontinuation of HMA therapy is associated with relapse, but this has not been systematically assessed. In this analysis, we study the outcomes of patients with MDS and AML treated with HMA in whom therapy was interrupted while in response. Methods: We included patients treated on 3 clinical trials of HMAs in which therapy discontinuation was considered after 12-24 months if a sustained response was achieved. We calculated progression-free survival (PFS) and overall survival (OS) after stopping therapy, and as a secondary objective, we explored clinical variables associated with outcome. Statistical analysis was performed with SPSS v.22. PFS was defined as time from drug discontinuation until progression or death from any cause; OS was defined as time from drug discontinuation to death from any cause. Estimated PFS and OS curves were calculated by the Kaplan-Meier method, and the log rank test was used to identify variables with influence on survival data. Results: From the initial 173 patients accrued in these trials, we identified 16 patients who had achieved complete or partial response (CR/PR) and who electively stopped treatment while response was maintained. Median age was 68 years (51-80). Diagnosis was AML in 10 patients (62%) and intermediate-2/high-risk MDS in 6 patients (38%); 81% of patients had not received any previous treatment. Patients received a median of 6 courses (1-14) and all achieved either CR (n=15; 94%) or PR (n=1; 6%). The median number of cycles until response was 1 (1-4). Therapy was stopped after receiving the maximum courses of treatment scheduled on protocol for 7 patients (44%) and by patient decision for the other 9 (56%). There were no treatment discontinuations due to side effects. Patients who received their whole protocol treatments received significantly more courses of therapy (12 vs 6; p=0.001) and tended to have longer times to progression or relapse from off-treatment date (24 vs 5.78; p=0.08). For the whole series, the estimated median OS and PFS were 15 months (95% confidence interval [CI]: 6-24) and 4 months (95% CI: 2-6), respectively. The main variable with impact on both OS and PFS was total number of courses of therapy. Patients who received more than 12 cycles of HMA showed significantly better median OS (20 months [95% CI: 12-27] vs 4 months [95% CI: 1-18]; p=0.043) and tended to have longer PFS (estimated PFS at 12 months: 50% vs 17%; p=0.062). Cytogenetics also had a significant influence on OS; those patients with high-risk cytogenetics had a poorer OS (estimated OS at 12 months: 33% vs 69%; p= 0.046). At last follow up, 2 patients are still alive and receiving active treatment, with a median follow up of 104 months (92-117). Eleven patients (69%) relapsed or progressed after discontinuing treatment, with a median of 4 months (2-68) from last course of therapy, and 5 died from a different cause while in response. After relapse, 7 out of 11 patients received other treatments for MDS/AML, and 2 patients responded to those further treatments. HMA were reintroduced in 6 patients, and only 1 was sensitive to HMA after the first failure. In total, 14 patients (88%) died, and progressive disease (PD) was the most frequent cause (9/14, 65%). Conclusion: When therapy was interrupted, loss of response was rapidly observed in most of patients, with a median of 4 months from end of treatment to progression or death. Additionally, although the number of patients was limited, we have identified two variables that could be associated with outcome: number of therapy courses administered before stopping therapy and cytogenetics. Based on these data and current information, discontinuation of HMA treatment should not be considered in the absence of any serious adverse event. In cases of discontinuation of treatment, number of courses received and cytogenetic risk seem to be important factors to predict outcome. Disclosures Borthakur: Tetralogic Pharmaceuticals: Research Funding. Cortes:Ariad: Consultancy, Research Funding; BMS: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; Pfizer: Consultancy, Research Funding; Teva: Consultancy, Research Funding. Ravandi:Cellerant Therapeutics: Research Funding. Kantarjian:ARIAD, Pfizer, Amgen: Research Funding. Garcia-Manero:Epizyme, Inc: Research Funding.
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Crosbie, John. "Interrupted time-series analysis with brief single-subject data." Journal of Consulting and Clinical Psychology 61, no. 6 (1993): 966–74. http://dx.doi.org/10.1037/0022-006x.61.6.966.
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Bintley, H. "Times series analysis with reveal." Fuzzy Sets and Systems 23, no. 1 (July 1987): 97–118. http://dx.doi.org/10.1016/0165-0114(87)90103-5.
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Linden, Ariel. "Challenges to validity in single‐group interrupted time series analysis." Journal of Evaluation in Clinical Practice 23, no. 2 (September 14, 2016): 413–18. http://dx.doi.org/10.1111/jep.12638.
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Ramsey, Patricia P., and Philip H. Ramsey. "Robust testing of level changes in interrupted time-series analysis." Journal of Statistical Computation and Simulation 76, no. 10 (October 2006): 913–23. http://dx.doi.org/10.1080/10629360500109069.
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Huitema, Bradley E. "Analysis of Interrupted Time-Series Experiments Using ITSE: A Critique." Understanding Statistics 3, no. 1 (February 2004): 27–46. http://dx.doi.org/10.1207/s15328031us0301_2.
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Shenoy, Amrita G., Charles E. Begley, Lee Revere, Stephen H. Linder, and Stephen P. Daiger. "Innovating patient care delivery: DSRIP's interrupted time series analysis paradigm." Healthcare 7, no. 1 (March 2019): 44–50. http://dx.doi.org/10.1016/j.hjdsi.2017.11.004.
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Crowley, Patrick, Hector E. Ramirez, JulieAnn Martel, Mark Stibich, Sarah Simmons, Deborah G. Passey, Yonhui Allton, et al. "100. Effect of Disinfection Tracking System on Cleaning Events of Portable Medical Equipment." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S180. http://dx.doi.org/10.1093/ofid/ofaa439.410.
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Abstract Background Portable Medical Equipment (PME) can play a vital role in transmission of multidrug-resistant organisms. Cleaning PME is challenging and protocols vary by institution. Tracking of PME cleaning events is usually performed manually and demonstration of compliance with protocols is difficult. We studied a Disinfection Tracking Systems (DTS) to understand its potential role in tracking disinfection events of PME and whether its implementation led to improvement in the number of cleaning events. The DTS device was designed to automatically register several types of disinfection events and could be set to display time since last disinfected on the screen. Methods For a 25-day period, a single acute care unit received a DTS device with the display screen off but with the ability to detect and log disinfection events in a database from a disinfectant wipe. After the 25-day screen-off period the DTS units screen was turned on to display the number of hours since the last recorded disinfection event (Figure 1) for a 42-day period. DTS devices were placed on 10 computer-on-wheels (COW) and 5 vitals machine (VM). An interrupted time series analysis, using a Bayesian model compared the number of events in the display screen-off to the screen-on period. Disinfection Tracking System with Screen-off and Screen-on Results During the 25-day screen-off period, there were a total of 345 events captured with 61 events on VM and 284 on COWs averaging 0.49 and 1.26 cleaning events for VM and COWs respectively per day. During the 42-day screen-on period, there were 845 total disinfection events with 104 events on VM and 741 events on COWs with 0.50 and 1.76 mean events for VM and COWs respectively per day. The mean events per device per day in the screen-on period for COW’s were 1.32 (1.10 – 1.57) times greater than those in the screen-off Period. The mean events per device per day in the screen-on period for VM devices was 1.37 (0.89 – 2.01) times greater than those in the screen-off period. Conclusion Disinfection events for COWs and VMs were found to be above the local policy requirements. Implementation of a DTS device was able to increase the rate of disinfection events for COWs potentially due to the prompt on the screen. Additionally, it captured disinfection events successfully on the database demonstrating its effective to be a tool for demonstration of compliance. Disclosures Mark Stibich, PhD MHS, Xenex Disinfection Services, Inc (Board Member, Employee) Sarah Simmons, DrPH, Xenex Disinfection Services (Employee, Shareholder) Chetan Jinadatha, MD, MPH, AHRQ (Research Grant or Support)Department of Veterans Affairs (Other Financial or Material Support, Owner: Department of Veterans Affairs. Licensed to: Xenex Disinfection System, San Antonio, TX)Inventor (Other Financial or Material Support, Methods for organizing the disinfection of one or more items contaminated with biological agents)NiH/NINR (Research Grant or Support)NSF (Research Grant or Support)Xenex Healthcare Services (Research Grant or Support)
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Peterson, Katherine, Lindsay Smith, John Ahern, and Bradley Tompkins. "The Impact of a Best-Practice Advisory on Inpatient Use of Piperacillin-Tazobactam." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s406—s407. http://dx.doi.org/10.1017/ice.2020.1057.
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Background: Antibiotic “time outs” have been identified as a way to decrease inappropriate use of antibiotics in hospitals.1 The University of Vermont Medical Center created a best-practice advisory (BPA) to alert clinicians to review piperacillin-tazobactam prescriptions after 72 hours (Fig. 1). Data examining the use of a BPA as a method to prompt clinicians to perform an antibiotic “time out” are limited. Objective: The purpose of our retrospective study was to evaluate the effectiveness of the BPA on the rate of piperacillin-tazobactam prescribing as measured by defined daily dose per 1,000 patient days (DDD). Methods: The BPA was integrated into the electronic health record and designed to activate once piperacillin-tazobactam has been prescribed for ≥72 hours. Under approval of the University of Vermont’s Institutional Review Board, administered data for piperacillin-tazobactam and 3 control antibiotics (cefazolin, ceftriaxone, and meropenem) were collected for 1 year prior to and 1 year following the launch of the BPA. Administered data were converted to DDD, and an interrupted time-series analysis was performed to evaluate for changes in antibiotic use. Results: The data included 7,094 patients in the preintervention group and 6,661 patients in the postintervention group. The BPA fired 1,478 times. The prescribing rate of piperacillin-tazobactam 1 year prior to the BPA was 32.34 DDD and decreased every month both before (−1.22 DDD) and after (−0.27 DDD) the BPA initiation, with no significant difference in prescribing trends (P = .10). Meropenem prescribing in the BPA era increased each month compared to the pre-BPA period (1.16 DDD; P = 0.02), whereas cefazolin use (P = .93) and ceftriaxone (P = .09) use did not significantly change. Conclusions: The data show that piperacillin-tazobactam utilization at our institution is decreasing. Considering that this trend started prior to the launch of the BPA and that rate of decline remained unchanged post-BPA, we conclude that the BPA did not further impact our piperacillin-tazobactam consumption. It is possible that other factors influencing prescribing account for the observed decline, including an institution-wide educational campaign regarding the appropriate use of broad-spectrum antibiotics that was initiated in the months prior to the BPA. The reason for the significant rise in meropenem post-BPA is unclear. This may be unrelated to the BPA; however, it requires further investigation.1. Core elements of hospital antibiotic stewardship programs. Centers for Disease Control and Prevention website. https://www.cdc.gov/antibioticuse/healthcare/implementation/core-elements.html. Updated July 19, 2019. Accessed October 6, 2019.Funding: NoneDisclosures: None
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Sharpley, Christopher F. "Time-Series Analysis of Behavioural Data: An Update." Behaviour Change 4, no. 4 (December 1987): 40–45. http://dx.doi.org/10.1017/s0813483900008329.
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Some recent developments in the use of interrupted time-series analysis (ITSA) are described with particular reference to the detection of effects with short data series such as those often encountered in applied behaviour analysis. The necessity to perform the sometimes troublesome model-identification procedure is questioned, and the likely incidence of Type 1 and 2 errors is discussed. Conclusions are drawn to suggest that ITSA may be safely applied to data that are typical of those collected in applied behaviour analysis.
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Ewusie, Joycelyne E., Lehana Thabane, Joseph Beyene, Sharon E. Straus, and Jemila S. Hamid. "MultiCenter Interrupted Time Series Analysis: Incorporating Within and Between-Center Heterogeneity." Clinical Epidemiology Volume 12 (June 2020): 625–36. http://dx.doi.org/10.2147/clep.s231843.
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Chen, Jing Bo, Jun Bao Zheng, Lei Yang, and Ya Ming Wang. "Change-Points Detections for Interrupted Time Series Analysis: A Literature Review." Applied Mechanics and Materials 462-463 (November 2013): 187–92. http://dx.doi.org/10.4028/www.scientific.net/amm.462-463.187.
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General review of Change-Points detection methods applied in Interrupted Time Series Analysis for recent years. Articles from domains like meteorology, hydrology, stock analysis, sequences mining et al. are compared together. The literatures range from the 1980s to 2013. The methods are generally classified in Parametric, Semi-Parametric, and Nonparametric. Some non-statistical methods are also mentioned in this review. Characters of each method are briefly summarized. As all methods mentioned in this review share a common purpose that to detect change-points, most of them can be used in other domains after some proper adjustment.
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Mpofu, Raphael Tabani. "Dollarization and economic development in Zimbabwe: An interrupted time-series analysis." Risk Governance and Control: Financial Markets and Institutions 5, no. 4 (2015): 38–48. http://dx.doi.org/10.22495/rgcv5i4art4.
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This paper examines the impact of dollarization on the performance of the Zimbabwean economy from 2003 to 2014 using an interrupted time-series analysis. In Zimbabwe’s case, dollarization was the official replacement of the Zimbabwean dollar with the U.S. dollar. Rapid dollarization in the economy was accelerated by the exogenous shock caused by the injection of cash dollars into the Zimbabwean economy, mostly from international transfers. Since the official adoption of dollarization, Zimbabwe is largely a cash-based economy, with a huge amount of U.S. dollars that are in circulation outside the banking system. A hands-off approach to currency management has served Zimbabwe well since 2009, but a number of risks are beginning to emerge as the economy has slowly regenerated itself and the need for large capital injections has increased. Macroeconomic data obtained from the World Bank and from the Reserve Bank of Zimbabwe’s Monthly Economic Review is analysed. According to the tests conducted, it was found that dollarization did introduce some macroeconomic stability in Zimbabwe although a few key macroeconomic variables showed a sustained improvement. Statistical analysis shows that increased dollarization had positively affected reversed the spiralling effects of hyperinflation that were prevalent prior to 2009, although inflationary pressures still continued, albeit at a slower pace. This research has implications not just for Zimbabwean policy makers as they grapple with decisions pertaining to re-adoption of a local currency and/or the continuation of the use of the US dollar and/or the adoption of a regional currency, for example, the South African rand. The African Union and specifically, the Southern Africa Development Community should look at these policy issues very closely in order to provide policy direction to its member states.
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Geue, Claudia, James D. Lewsey, Daniel F. MacKay, Grace Antony, Colin M. Fischbacher, Jill Muirie, and Gerard McCartney. "Scottish Keep Well health check programme: an interrupted time series analysis." Journal of Epidemiology and Community Health 70, no. 9 (April 12, 2016): 924–29. http://dx.doi.org/10.1136/jech-2015-206926.
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PEREZ, A. "An interrupted time series analysis of parenteral antibiotic use in Colombia." Journal of Clinical Epidemiology 56, no. 10 (October 2003): 1013–20. http://dx.doi.org/10.1016/s0895-4356(03)00163-x.
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Harrop, John W., and Wayne F. Velicer. "Computer Programs for Interrupted Time Series Analysis: I. A Qualitative Evaluation." Multivariate Behavioral Research 25, no. 2 (April 1990): 219–31. http://dx.doi.org/10.1207/s15327906mbr2502_12.
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Harrop, John W., and Wayne F. Velicer. "Computer Programs for Interrupted Time Series Analysis: II A Quantitative Evaluation." Multivariate Behavioral Research 25, no. 2 (April 1990): 233–48. http://dx.doi.org/10.1207/s15327906mbr2502_13.
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Linden, Ariel. "Conducting Interrupted Time-series Analysis for Single- and Multiple-group Comparisons." Stata Journal: Promoting communications on statistics and Stata 15, no. 2 (June 2015): 480–500. http://dx.doi.org/10.1177/1536867x1501500208.
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Morgan, Oliver W., Clare Griffiths, and Azeem Majeed. "Interrupted Time-Series Analysis of Regulations to Reduce Paracetamol (Acetaminophen) Poisoning." PLoS Medicine 4, no. 4 (April 3, 2007): e105. http://dx.doi.org/10.1371/journal.pmed.0040105.
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Cooney, John B., John Clarke, and Grant L. Morris. "Analysis of the physiological stress profile: The interrupted time-series design." Biofeedback and Self-Regulation 11, no. 3 (September 1986): 231–45. http://dx.doi.org/10.1007/bf01003482.
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Newton, H. J. "TIMESLAB: A Times Series Analysis Laboratory." Biometrics 45, no. 1 (March 1989): 346. http://dx.doi.org/10.2307/2532075.
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Spiers, Gemma, Victoria Allgar, Gerry Richardson, Kate Thurland, Sebastian Hinde, Yvonne Birks, Kate Gridley, et al. "Transforming community health services for children and young people who are ill: a quasi-experimental evaluation." Health Services and Delivery Research 4, no. 25 (September 2016): 1–222. http://dx.doi.org/10.3310/hsdr04250.
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BackgroundChildren’s community nursing (CCN) services support children with acute, chronic, complex and end-of-life care needs in the community.ObjectivesThis research examined the impact of introducing and expanding CCN services on quality, acute care and costs.MethodsA longitudinal, mixed-methods, case study design in three parts. The case studies were in five localities introducing or expanding services. Part 1: an interrupted time series (ITS) analysis of Hospital Episode Statistics on acute hospital admission for common childhood illness, and bed-days and length of stay for all conditions, including a subset for complex conditions. The ITS used between 60 and 84 time points (monthly data) depending on the case site. Part 2: a cost–consequence analysis using activity data from CCN services and resource-use data from a subset of families (n = 32). Part 3: in-depth interviews with 31 parents of children with complex conditions using services in the case sites and a process evaluation of service change with 41 NHS commissioners, managers and practitioners, using longitudinal in-depth interviews, focus groups and documentary data.FindingsPart 1: the ITS analysis showed a mixed pattern of impact on acute activity, with the greatest reductions in areas that had rates above the national average before CCN services were introduced and significant reductions in some teams in acute activity for children with complex conditions. Some models of CCN appear to have more potential for impact than others. Part 2: the cost–consequence analysis covered only part of the CCN teams’ activity. It showed some potential savings from reduced admissions and bed-days, but none that was greater than the total cost of the services. Part 3: three localities implemented services as planned, one achieved partial service change and one was not able to achieve any service change. Organisational stability, finance, medical stakeholder support, competition, integration with primary care and visibility influenced the planning and implementation of new and expanded CCN services. Feeling supported to manage their ill child at home was a key outcome of using services for parents. Various service features contributed to this and were important in different ways at different times. Other outcomes included being able to avoid hospital care, enabling the child to stay in school, and getting respite. Although parents judged that care was of high quality when teams enabled them to feel supported, reassured and secure in managing their ill child at home, this did not depend on a constant level of contact from teams.LimitationsDelays in service reconfigurations required adaptation of research activity across sites. Use of administrative data, such as Hospital Episode Statistics, for research purposes is technically difficult and imposed some limitations on both the ITS and the cost–consequence analyses.ConclusionsLarge, generic CCN teams that integrate acute admission avoidance for all children with support for children with complex conditions and highly targeted teams for children with complex conditions offer the possibility of supporting children more appropriately at home while also making some difference to acute activity. This possibility remains to be tested further.Future workFurther work should refine the evidence on outcomes of services by looking at outcomes in promising models, value for money and measuring quality-based outcomes.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.
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Linden, Ariel. "A Comprehensive set of Postestimation Measures to Enrich Interrupted Time-series Analysis." Stata Journal: Promoting communications on statistics and Stata 17, no. 1 (March 2017): 73–88. http://dx.doi.org/10.1177/1536867x1701700105.
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While the primary goal of interrupted time-series analysis (ITSA) is to evaluate whether there is a change in the level or trend of an outcome following an interruption (for example, policy change, intervention initiation), a series of additional measures may be relevant to the analysis. In this article, I seek to fill a gap in the ITSA literature by describing a comprehensive set of measures that can be computed following ITSA models, including those that fulfill the primary goal and those that provide supplementary information about trends. These measures can be calculated using the itsa command; this article therefore serves as a complement to “Conducting interrupted time-series analysis for single and multiple group comparisons” (Linden, 2015, Stata Journal 15: 480–500), which introduced the itsa command. Specific ITSA postestimation measures described in this article include individual trend lines, comparisons between multiple interventions, and comparisons with a counterfactual.
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Bayly, P. V., J. E. Halley, B. P. Mann, and M. A. Davies. "Stability of Interrupted Cutting by Temporal Finite Element Analysis." Journal of Manufacturing Science and Engineering 125, no. 2 (April 15, 2003): 220–25. http://dx.doi.org/10.1115/1.1556860.
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Chatter in milling and other interrupted cutting operations occurs at different combinations of speed and depth of cut from chatter in continuous cutting. Prediction of stability in interrupted cutting is complicated by two facts: (1) the equation of motion when cutting is not the same as the equation when the tool is free; (2) no exact analytical solution is known when the tool is in the cut. These problems are overcome by matching the free response with an approximate solution that is valid while the tool is cutting. An approximate solution, not restricted to small times in the cut, is obtained by the application of finite elements in time. The complete, combined solution is cast in the form of a discrete map that relates position and velocity at the beginning and end of each element to the corresponding values one period earlier. The eigenvalues of the linearized map are used to determine stability. This method can be used to predict stability for arbitrary times in the cut; the current method is applicable only to a single degree of freedom. Predictions of stability for a 1-degree of freedom case are confirmed by experiment.