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Interrupted Time Series

Hanh Ngo, Roberto Forero, David Mountain, Daniel Fatovich, Wing Nicola Man, Peter Sprivulis, Mohammed Mohsin, Sam Toloo, Antonio Celenza, Gerard Fitzgerald, Sally McCarthy, Ken Hillman
BACKGROUND: In 2009, the Western Australian (WA) Government introduced the Four-Hour Rule (FHR) program. The policy stated that most patients presenting to Emergency Departments (EDs) were to be seen and either admitted, transferred, or discharged within 4 hours. This study utilised de-identified data from five participating hospitals, before and after FHR implementation, to assess the impact of the FHR on several areas of ED functioning. METHODS: A state (WA) population-based intervention study design, using longitudinal data obtained from administrative health databases via record linkage methodology, and interrupted time series analysis technique...
2018: PloS One
Hee-Jung Park, Jun Hyup Lee, Sujin Park, Tae-Il Kim
Purpose: This study utilized a strong quasi-experimental design to test the hypothesis that the implementation of a policy to expand dental care services resulted in an increase in the usage of dental outpatient services. Methods: A total of 45,650,000 subjects with diagnoses of gingivitis or advanced periodontitis who received dental scaling were selected and examined, utilizing National Health Insurance claims data from July 2010 through November 2015. We performed a segmented regression analysis of the interrupted time-series to analyze the time-series trend in dental costs before and after the policy implementation, and assessed immediate changes in dental costs...
February 2018: Journal of Periodontal & Implant Science
Zaina AlBalawi, Leah Gramlich, Gregg Nelson, Peter Senior, Erik Youngson, Finlay A McAlister
BACKGROUND: The Enhanced Recovery After Surgery (ERAS) program has been shown to reduce length of stay (LOS) in colorectal surgical patients in randomized trials. The impact outside of trial settings, or in subgroups of patients excluded from trials such as individuals with diabetes, is uncertain. We conducted this study to evaluate the impact of ERAS implementation in Alberta, Canada. METHODS: This is a retrospective cohort study and interrupted time series analysis using linked administrative data to examine LOS and postoperative outcomes in the 12 months pre- and post-implementation of ERAS in 2013 for all adults undergoing elective colorectal surgery...
March 12, 2018: World Journal of Surgery
B Josea Kramer, Beth Creekmur, Michael N Mitchell, Debra Saliba
BACKGROUND/OBJECTIVES: Home-based primary care (HBPC) is a comprehensive, interdisciplinary program to meet the medical needs of community-dwelling populations needing long-term care (LTC). The U.S. Department of Veterans Affairs (VA) expanded its HBPC program to underserved rural communities, including American Indian reservations, providing a "natural laboratory" to study change in access to VA LTC benefits and utilization outcomes for rural populations that typically face challenges in accessing LTC medical support...
March 12, 2018: Journal of the American Geriatrics Society
Changwoo Han, Yun-Chul Hong
The first ferronickel manufacturing factory of the Republic of Korea was opened in Gwangyang City on October, 23rd, 2008. There has been public concern regarding heavy metal dust blown from the factory and slag disposal site. Therefore, we evaluated the health impact of the ferronickel factory on Gwangyang City residents by using interrupted time series analysis. We analyzed the monthly incidence patterns of asthma, allergic rhinitis, and dermatitis in Gwangyang City residents from 2004 to 2014. Data were gathered from the National Health Insurance Service database which covers all the hospital use data of entire city residents...
March 7, 2018: Environment International
Katy B Kozhimannil, Peiyin Hung, Carrie Henning-Smith, Michelle M Casey, Shailendra Prasad
Importance: Hospital-based obstetric services have decreased in rural US counties, but whether this has been associated with changes in birth location and outcomes is unknown. Objective: To examine the relationship between loss of hospital-based obstetric services and location of childbirth and birth outcomes in rural counties. Design, Setting, and Participants: A retrospective cohort study, using county-level regression models in an annual interrupted time series approach...
March 8, 2018: JAMA: the Journal of the American Medical Association
William Kazanis, Mary J Pugh, Claudina Tami, Joseph K Maddry, Vikhyat S Bebarta, Erin P Finley, Don D McGeary, David H Carnahan, Jennifer S Potter
Introduction: Between 2001 and 2009, opioid analgesic prescriptions in the Military Health System quadrupled to 3.8 million. The sheer quantity of opioid analgesics available sets the stage for issues related to misuse, abuse, and diversion. To address this issue, the Department of Defense implemented several directives and clinical guidelines to improve access to appropriate pain care and safe opioid prescribing. Unfortunately, little has been done to characterize changing patterns of opioid use in active duty service members (ADSM), so little is known about how combat operations and military health care policy may have influenced this significant problem...
March 1, 2018: Military Medicine
Xiaolei Xiong, Zhiguo Zhang, Jing Ren, Jie Zhang, Xiaoyun Pan, Liang Zhang, Shiwei Gong, Si Jin
BACKGROUND: China's universal medical insurance system (UMIS) is designed to promote social fairness through improving access to medical services and reducing out-of-pocket (OOP) costs for all Chinese. However, it is still not known whether UMIS has a significant impact on the accessibility of medical service supply and the affordability, as well as the seeking-care choice, of patients in China. METHODS: Segmented time-series regression analysis, as a powerful statistical method of interrupted time series design, was used to estimate the changes in the quantity and quality of medical service supply before and after the implementation of UMIS...
2018: PloS One
Shabbar I Ranapurwala, Ryan M Carnahan, Grant Brown, Jessica Hinman, Carri Casteel
Objective: To evaluate the impact of Iowa's prescription monitoring program (PMP), implemented in 2009, on opioid pain reliever (OPR) prescribing patterns. Methods: We conducted interrupted time series analyses using 2003-2014 health insurance claims from a private health insurer in Iowa. OPR prescriptions for all beneficiaries were included. Another data set included only OPR prescription for new opioid users required to have six months of insurance coverage. We evaluate four OPR prescribing patterns: 1) average daily dosage in morphine milligrams equivalents (MME), 2) MME per prescription, 3) average days' supply per prescription, and 4) prescription rate per 1,000 insured person-years...
March 2, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Brent A Becker, Barbara A Stahlman, Nathaniel McLean, Erik I Kochert
OBJECTIVE: The study sought to evaluate changes in mortality and resource utilization in patients with low level troponin elevations following a reduction in the cutoff for normal troponin I (TnI) from 0.5 ng/mL to the 99th percentile (0.06 ng/mL). METHODS: This was an interrupted time series comparing emergency department (ED) patients with possible acute coronary syndrome (ACS) and TnI values 0.06-0.5 ng/mL before and after an institutional decrease in the TnI cutoff...
February 3, 2018: American Journal of Emergency Medicine
Haiya Yan, Ling-Qun Hu, Yun Wu, Qihui Fan, Cynthia A Wong, Robert J McCarthy
BACKGROUND: Autologous transfusion of intraoperative cell salvage blood may be a potential method to decrease the need for allogeneic packed red blood cell transfusions after cesarean delivery, although there are limited data on the benefits of this method. This study evaluated the implementation of targeted intraoperative cell salvage during cesarean delivery in women at increased risk for hemorrhage at the Women's and Children's Hospital in Ningbo, China. METHODS: All women who underwent cesarean delivery >28 weeks of gestation were included in the study...
March 1, 2018: Anesthesia and Analgesia
Niam Yaraghi, Ram D Gopal
Policy Points: Frequent data breaches in the US health care system undermine the privacy of millions of patients every year-a large number of which happen among business associates of the health care providers that continue to gain unprecedented access to patients' data as the US health care system becomes digitally integrated. Implementation of the HIPAA Omnibus Rules in 2013 has led to a significant decrease in the number of privacy breach incidents among business associates. CONTEXT: Frequent data breaches in the US health care system undermine the privacy of millions of patients every year...
March 2018: Milbank Quarterly
Ali Ghobadi, Patrick J Van Winkle, Michael Menchine, Qiaoling Chen, Brian Z Huang, Adam L Sharp
OBJECTIVE: Opioid prescribing guidelines are commonly seen as part of the solution to America's opioid epidemic. However, the effectiveness of specific treatment guidelines on altering opioid prescribing in the Emergency Department (ED) is unclear. We examined provider ordering patterns before and after implementation of opioid use guidelines for ED patients overall and the specific subsets of ED patients with either chronic opioid use or fracture. METHODS: We conducted a pre-post interrupted time series analysis of adult (≥18 years old) ED encounters in 14 integrated community EDs before (2013) and after (2014) the implementation of opioid prescribing guidelines...
March 1, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Jonathan Brett, Andrea Schaffer, Timothy Dobbins, Nicholas A Buckley, Sallie-Anne Pearson
PURPOSE: To evaluate the impact of 2 policy changes on quetiapine dispensing in Australia: removal of prior authorisation for prescribing (policy 1: July 2007) and removal of repeat prescriptions for 25-mg quetiapine (policy 2: January 2014). METHODS: We performed an interrupted time series analysis using Pharmaceutical Benefits Scheme claims data (July 2005 to December 2015). We assessed the impact of both policies on monthly quetiapine dispensing (25 mg and >25 mg) and the impact of policy change 2 on monthly rates of 25-mg discontinuation and switching from 25 mg to other quetiapine strengths...
February 28, 2018: Pharmacoepidemiology and Drug Safety
Simon J C Davies, Binu Jacob, David Rudoler, Juveria Zaheer, Claire de Oliveira, Paul Kurdyak
Background: Although commonly used in anxiety and insomnia, recent guidelines recommend caution when prescribing benzodiazepines in the elderly. Here we examined rates of benzodiazepine prescribing to older adults in Ontario, Canada from 1998 to 2013 and impact of legislation that made prescribing regulations more strict. Method: Annual benzodiazepine prescription rates for Ontario residents aged 65 and over were examined using the Ontario Drug Benefit database which captures all publicly funded prescriptions...
March 2018: Therapeutic Advances in Psychopharmacology
Hsien-Yen Chang, Irene Murimi, Mark Faul, Lainie Rutkow, G Caleb Alexander
PURPOSE: We quantified the effects of Florida's prescription drug monitoring program and pill mill law on high-risk patients. METHODS: We used QuintilesIMS LRx Lifelink data to identify patients receiving prescription opioids in Florida (intervention state, N: 1.13 million) and Georgia (control state, N: 0.54 million). The preintervention, intervention, and postintervention periods were July 2010 to June 2011, July 2011 to September 2011, and October 2011 to September 2012...
February 28, 2018: Pharmacoepidemiology and Drug Safety
Celso Augusto Guimarães Santos, Reginaldo Moura Brasil Neto, Richarde Marques da Silva, Jacqueline Sobral de Araújo Passos
Trend analysis is an important issue for the decision-making processes. Thus, trends of rainfall, consecutive dry days (CDD), and consecutive wet days (CWD) in the Upper São Francisco River basin, Brazil, using daily rainfall data from the Tropical Rainfall Measuring Mission (TRMM) for recent 18 years, were analyzed. Instead of analyzing the trend of one average time series for one specific confidence level, a spatiotemporal analysis over the entire area with 169 continuous time series is done by applying the nonparametric Mann-Kendall and Sen tests for simultaneously 13 confidence levels and a new integrated confidence classification is proposed...
February 26, 2018: Environmental Monitoring and Assessment
Rachel A Crockett, Sarah E King, Theresa M Marteau, A T Prevost, Giacomo Bignardi, Nia W Roberts, Brendon Stubbs, Gareth J Hollands, Susan A Jebb
BACKGROUND: Nutritional labelling is advocated as a means to promote healthier food purchasing and consumption, including lower energy intake. Internationally, many different nutritional labelling schemes have been introduced. There is no consensus on whether such labelling is effective in promoting healthier behaviour. OBJECTIVES: To assess the impact of nutritional labelling for food and non-alcoholic drinks on purchasing and consumption of healthier items. Our secondary objective was to explore possible effect moderators of nutritional labelling on purchasing and consumption...
February 27, 2018: Cochrane Database of Systematic Reviews
Donna Moralejo, Regina El Dib, Rafaela A Prata, Pasqual Barretti, Ione Corrêa
BACKGROUND: 'Standard Precautions' refers to a system of actions, such as using personal protective equipment or adhering to safe handling of needles, that healthcare workers take to reduce the spread of germs in healthcare settings such as hospitals and nursing homes. OBJECTIVES: To assess the effectiveness of interventions that target healthcare workers to improve adherence to Standard Precautions in patient care. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL, LILACS, two other databases, and two trials registers...
February 26, 2018: Cochrane Database of Systematic Reviews
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[This corrects the article DOI: 10.1371/journal.pmed.1002427.].
February 2018: PLoS Medicine
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