Regression Analysis Of Interrupted Time Series Research Articles

Implementation of the 2015 American Thyroid Association guideline changes across a health system: A quality improvement opportunity

BackgroundWith the release of the 2015 management guidelines, the American Thyroid Association narrowed the indications for postoperative radioactive iodine (RAI) in well-differentiated thyroid cancer. However, the adoption of new guidelines varies between healthcare entities. The goal of this study was to characterize the appropriateness of RAI use within our health system, before and after the 2015 guideline changes. MethodsIn this retrospective cohort study, we identified patients who were treated for well-differentiated thyroid cancer between 2011–2020. Patients were characterized as “undertreated,” “appropriately treated,” or “overtreated” with RAI. Variation in RAI use was assessed using interrupted time series and multivariable logistic regression analyses. ResultsAmong 6310 patients, the mean age was 50 ± 15 years, and 74% were female. There was an immediate drop in the likelihood of receiving RAI after the release of the 2015 guidelines (p = 0.016), and the likelihood of receiving RAI therapy continued to significantly decline over time (OR 0.83, p < 0.001). Despite this trend in the absolute rate of RAI use, there was a significant increase in overtreatment with RAI after the release of the 2015 guidelines (p < 0.001), indicating imperfect uptake of the new criteria. Two hospitals within the health system were identified as disproportionate contributors to overtreatment (Hospital 4: OR 6.50, p < 0.001; Hospital 6: OR 8.63, p < 0.001). ConclusionsWhile the use of postoperative RAI was largely appropriate across our health system, rates of guideline adherence differed between hospitals. Efforts to standardize treatment protocols systemwide may enable more rapid and consistent uptake of new management guidelines.

The Origin of Electoral Absenteeism in Early Italy: New Evidence to Explain North–South Diverging Trends

Abstract Low turnout rates with high geographical disparities characterized Italian national elections in the first six decades after the country’s founding in 1861. Historians have largely overlooked these regional voting differences and their potential economic implications. A multiple-group interrupted time series analysis regression model demonstrates distinct electoral trends between the Center-North and the South, coinciding with electoral reforms in 1894 that affected electoral competition, particularly in the South. Furthermore, a random effect panel regression model reveals determinants of regional abstention rates, which indicate that different factors influenced abstention rates in the Center-North than in the South, emphasizing the relevance of political factors in the creation and widening of regional divergences in Italy.

Impact of the Choose Well Contraceptive Access Initiative on Method Use Among Women Enrolled in South Carolina's Medicaid Program: A Mid-line Assessment.

A 6-year statewide contraceptive access initiative focused on equitable access to contraception, removing cost barriers, capacity building and training, raising consumer awareness, and expanding contraceptive care at safety net clinics was implemented in South Carolina beginning in 2017. This study assessed changes in contraceptive method use among women enrolled in the South Carolina Medicaid program during the first 3 years of Choose Well. Contraception use among a retrospective cohort of women aged 15 to 45 enrolled in South Carolina Medicaid from 2012 to 2020 was examined. Interrupted time series regression analysis was used to assess changes in the use of intrauterine devices (IUDs) and contraceptive implants between 2012 and 2016 and 2017 and 2020. Analyses were conducted for all women and stratified by age groups. Long-acting reversible contraception use increased from 8.5% during the pre-Choose Well period to 10.9% during the Choose Well period (p<.001), with IUD use increasing from 4.3% to 5.2% (p<.001) and implant use increasing from 4.6% to 6.0% (p<.001). The interrupted time series analysis found a significant positive change in the average level of monthly IUD use after Choose Well began (0.493 percentage points; 95% confidence interval,0.311-0.675). The effect was stronger among women 20 to 25years of age. Choose Well significantly increased the trend in IUD use among all women by a positive 0.013 percentage points (95% confidence interval,0.006-0.020) per month beyond expected values. At the mid-point of the Choose Well Evaluation, the use of IUD methods increased significantly beyond what would be expected had pre-Choose Well trends continued. This was particularly evident among women 20 to 25years of age. These findings suggest that Choose Well succeeded in reducing barriers to the use of IUDs.

Evaluating the Effect of COVID-19 on Outpatient Opioid Utilization Among Health First Colorado Members and a National Non-Medicaid Cohort: An Interrupted Time Series Analysis.

COVID-19, coinciding with the opioid epidemic in the United States, has had significant impacts on health-care utilization. While mixed, early analyses signaled a potential resurgence in opioid use following the pandemic. The primary study objective was to assess the association of the COVID-19 pandemic with opioid utilization among Health First Colorado (Colorado's Medicaid Program) members and a non-Medicaid managed care cohort who did not have a diagnosis of cancer or sickle cell disease. Using an interrupted time series and segmented regression analysis, this population-level study assessed the association of the COVID-19 pandemic on prescribed utilization of long- and short-acting opioid analgesics among Health First Colorado members and a random sample of non-Medicaid managed care members. Pharmacy claims data for both cohorts were assessed between October 1, 2018, and September 30, 2021, with April 2020 identified as the interruption of interest. We evaluated the following monthly opioid use measures separately for short-acting and long-acting opioids: number of members filling an opioid, total fills, and total days supplied. Short- and long-acting opioid utilization was significantly decreasing among Health First Colorado members in the 18 months prior to the start of COVID-19. After the onset of the pandemic, utilization stabilized and slopes were not significantly different from zero. Among the non-Medicaid managed care cohort, short- and long-acting opioid utilization significantly decreased in the 18 months leading up to the onset of the pandemic. After the onset of the pandemic, utilization of long-acting opioids stabilized, while utilization of short-acting opioids significantly increased. While we observed an increase in opioid utilization measures post-pandemic in the non-Medicaid managed care cohort, a similar increase was not observed in Health First Colorado members suggesting that thoughtful opioid policies put in place pre-pandemic may have been effective at controlling potential inappropriate opioid utilization.

Reducing low-value ED coags across 11 hospitals in a safety net setting

BackgroundProthrombin/international normalized ratio and activated partial thromboplastin time (PT/INR and aPTT) are frequently ordered in emergency departments (EDs), but rarely affect management. They offer limited utility outside of select indications. Several quality improvement initiatives have shown reduction in ED use of PT/INR and aPTT using multifaceted interventions in well-resourced settings. Successful reduction of these low-value tests has not yet been shown using a single intervention across a large hospital system in a safety net setting. This study aims to determine if an intervention of two BPAs is associated with a reduction in PT/INR and aPTT usage across a large safety net system. MethodsThis initiative was set at a large safety net system in the United States with 11 acute care hospitals. Two Best Practice Advisories (BPAs) discouraging inappropriate PT/INR and aPTT use were implemented from March 16, 2022-August 30, 2022. Order rate per 100 ED patients during the pre-intervention period was compared to the post-intervention period on both the system and individual hospital level. Complete blood count (CBC) testing served as a control, and packed red blood cell transfusions served as a balancing measure. An interrupted time series regression analysis was performed to capture immediate and temporal changes in ordering for all tests in the pre and post-intervention periods. ResultsPT/INR tests exhibited an absolute decline of 4.11 tests per 100 ED encounters (95% confidence interval −5.17 to −3.05; relative reduction of 18.9%). aPTT tests exhibited absolute decline of 4.03 tests per 100 ED encounters (95% CI −5.10 to −2.97; relative reduction of 19.8%). The control measure, CBC, did not significantly change (−0.43, 95% CI −2.83 to 1.96). Individual hospitals showed variable response, with absolute reductions from 2.02 to 9.6 tests per 100 ED encounters for PT/INR (relative reduction 12.1%–30.5%) and 2.07 to 10.04 for aPTT (relative reduction 12.1%–31.4%). Regression analysis showed that the intervention caused an immediate 25.7% decline in PT/INR and 24.7% decline in aPTT tests compared to the control measure. The slope differences (rate of order increase pre vs post intervention) did not significantly decline compared to the control. ConclusionsThis BPA intervention reduced PT/INR and aPTT use across 11 EDs in a large, urban, safety net system. Further study is needed in implementation to other non-safety net settings.

Effect of COVID-19 pandemic on serious mental illness-related outpatient department utilization in Ningbo, China: an interrupted time series analysis.

Globally, the coronavirus disease 2019 (COVID-19) pandemic has negatively affected mental health services, but there is no clear evidence of this in China. Therefore, we examined the effect of the COVID-19 pandemic on the use of serious mental illness (SMI)-related outpatient services in Ningbo, China. We analyzed the trends in monthly SMI-related outpatient department utilization from January 2018 to June 2022 using interrupted time series (ITS) regression analysis, and we defined the onset of the COVID-19 pandemic as January 2020. We also performed ITS regression analyses for sex and age subgroups. A significant difference in the monthly number of outpatient visit slopes before and after the onset of the pandemic was shown in the SMI analysis [-175.6, 95% confidence interval (CI) (-338.3 to -12.9), p < 0.05]. All sex and age categories, except the 20-30 years age category, showed statistically significant changes in their slopes after the onset of the pandemic. Significant differences in the number of outpatient visit slopes before and after the onset of the pandemic were seen for schizophrenia and bipolar disorders [-153.3, 95% CI (-294.1 to -12.5) and -16.8 (-31.0 to -2.6), respectively]. Moreover, a negative relationship was observed between the monthly number of outpatient visits and the number of incidents and accidents due to SMI (r = -0.38, p < 0.05). The COVID-19 pandemic has had a negative effect on SMI-related outpatient visits in Ningbo, especially by patients with schizophrenia. A strategy should be developed and implemented to maintain access to SMI services during the COVID-19 pandemic.

Effects of a Province-wide Triaging System for TIA: The ASPIRE Intervention.

Urgent transient ischemic attack (TIA) management to reduce stroke recurrence is challenging, particularly in rural and remote areas. In Alberta, Canada, despite an organized stroke system, data from 1999 to 2000 suggested that stroke recurrence after TIA was as high as 9.5% at 90 days. Our objective was to determine whether a multifaceted population-based intervention resulted in a reduction in recurrent stroke after TIA. In this quasi-experimental health services research intervention study, we implemented a TIA management algorithm across the entire province, centered around a 24-hour physician's TIA hotline and public and health provider education on TIA. From administrative databases, we linked emergency department discharge abstracts to hospital discharge abstracts to identify incident TIAs and recurrent strokes at 90 days across a single payer system with validation of recurrent stroke events. The primary outcome was recurrent stroke; with a secondary composite outcome of recurrent stroke, acute coronary syndrome, and all-cause death. We used an interrupted time series regression analysis of age-adjusted and sex-adjusted stroke recurrence rates after TIA, incorporating a 2-year preimplementation period (2007-2009), a 15-month implementation period, and a 2-year postimplementation period (2010-2012). Logistic regression was used to examine outcomes that did not fit the time series model. We assessed 6,715 patients preimplementation and 6,956 patients postimplementation. The 90-day stroke recurrence rate in the pre-Alberta Stroke Prevention in TIA and mild Strokes (ASPIRE) period was 4.5% compared with 5.3% during the post-ASPIRE period. There was neither a step change (estimate 0.38; p = 0.65) nor slope change (parameter estimate 0.30; p = 0.12) in recurrent stroke rates associated with the ASPIRE intervention implementation period. Adjusted all-cause mortality (odds ratio 0.71, 95% CI 0.56-0.89) was significantly lower after the ASPIRE intervention. The ASPIRE TIA triaging and management interventions did not further reduce stroke recurrence in the context of an organized stroke system. The apparent lower mortality postintervention may be related to improved surveillance after events identified as TIAs, but secular trends cannot be excluded. This study provides Class III evidence that a standardized population-wide algorithmic triage system for patients with TIA did not reduce recurrent stroke rate.

Diarrhea don’ts: Reducing inappropriate stool cultures and ova and parasite testing for nosocomial diarrhea

Diarrhea that develops in patients after 72 hours of hospitalization is likely to have a nosocomial or iatrogenic etiology. Testing with stool cultures and stool ova and parasites (O&P) is not recommended. Our goal was to reduce this inappropriate testing within a large, urban safety-net hospital system. This was a quality improvement project. We created a best practice advisory (BPA) within the electronic medical record that fires when a stool culture or O&P order is placed 72 hours after admission for any immunocompetent patient. It states that stool testing is low yield and offers the option to remove the order. We measured weekly counts of stool culture and stool O&P orders pre- and postintervention. We also measured the BPA acceptance rate, the 24-hour stool testing reorder rate, and Clostridioides difficile infection rates. Data were analyzed using Welch tests as well as a quasi-experimental pre- and postintervention interrupted time series regression analysis. Stool culture orders decreased by 24.4% (P < .001). There was a significant level difference and slope difference with linear regression. Five of the 11 hospitals had a significant reduction in stool culture orders. Stool O&P orders decreased by 18.2% (P < .01). Three of the 11 hospitals had a significant reduction in stool O&P orders. Our intervention successfully reduced inappropriate stool testing within a large safety-net hospital system.

The Association Between Media-Based Exposure to Nonsuicidal Self-Injury and Emergency Department Visits for Self-Harm

This study aimed to evaluate the association between media-based exposure to nonsuicidal self-injury (NSSI) and emergency department (ED) visits due to self-harm in Korea, specifically before and after the initial broadcast of the song Barcode, which has an explicit focus on NSSI. We used the national emergency department information system to obtain data related to ED visits due to self-harm between January 1, 2014, and December 31, 2018. Using interrupted time series regression analysis, we assessed the monthly ED visits due to self-harm before and after the media-based exposure to NSSI on March 30, 2018. In addition, self-harm methods were assessed. A total of 35,928,834 visits to ED were identified, of which 115,647 were due to self-harm. ED visits due to self-harm showed a significant step increase in the 10- to 14-year-old (β= 0.883, p= .001), 15- to 19-year-old (β= 2.941, p< .001), 20- to 24-year-old (β= 1.997, p= 0.002), and 25- to 29-year-old (β= 1.438, p= .029) age groups, before and after the media-based exposure to NSSI. The most pronounced increase was observed in male participants aged 20 to 24 years (β= 1.790, p= .012) and female participants aged 15 to 19 years (β= 5.158, p< .001). Self-harm by cutting has increased significantly in participants aged 10 to 29 years, and self-harm by poisoning has also increased significantly in participants aged 10 to 19 and 25 to 29 years. ED visits due to self-harm increased significantly, especially in adolescents and young adults, following the exposure to NSSI. Responsible media reporting on NSSI and appropriate guidelines would help prevent a further increase in self-harm. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Impact of COVID-19 Pandemic in Antibiotic Consumption in Navarre (Spain): An Interrupted Time Series Analysis

On 11 March 2020, the World Health Organization declared coronavirus disease 19 (COVID-19) a global pandemic. This exceptional situation changed the world not only in terms of mortality and morbidity, but also in terms of epidemiology and health system resources consumption. The objective of this work was to analyze the consumption of antibiotics during the period around the pandemic in our region. A drug utilization study was performed comparing the antibiotic consumption in the community during the years 2018, 2019, 2020, and 2021. Quarterly antibiotic use (defined daily doses (DDD) per 1000 inhabitants per day (DID)) and number of patients treated were the outcomes. Interrupted time series regression analysis was performed to estimate the statistical significance of the change in level of consumption before and after the COVID-19 pandemic. The drop of global antibiotic consumption was statistically significant, both in number of patients and in DID when analyzing pre-pandemic period versus pandemic period. The use of strategic antibiotics for respiratory infections such as amoxicillin, amoxicillin-clavulanic acid, and levofloxacin also decreased significantly. Seasonal pattern of use of antibiotics disappeared due to the global measures imposed over the world to work against COVID-19.

Trends in the Rates of Extended-Spectrum-β-Lactamase-Producing Enterobacterales Isolated from Urine Cultures during the COVID-19 Pandemic in Ontario, Canada.

Worldwide, extended-spectrum β-lactamase (ESBL) rates are increasing at an alarming level with increasing rates of health care exposures, international travel, and antibiotic usage. In this study, we investigated whether enhanced social isolation, travel restrictions, and the reduced use of antibiotics in Ontario, Canada during coronavirus disease 2019 (COVID-19) pandemic had an impact on ESBL rates in urine cultures collected from the community and long-term-care (LTC) facilities across the province. Data from a total of 8.6 million urine cultures performed at LifeLabs Ontario from 2016 to 2021 were utilized for analysis. ESBL-producing Escherichia coli (ESBL Escherichia coli) and ESBL Klebsiella pneumoniae were identified using standard operating procedures. Data trends were estimated by interrupted time series (ITS) regression analysis. Among 2.3 million positive urine cultures, 48.9% and 7.2% grew E. coli and K. pneumoniae, of which 5.8% and 3.3% produced ESBLs, respectively. While the overall rate of ESBL isolation was higher in the pandemic period than in the prepandemic period, by ITS regression analysis of the monthly rates of ESBL isolation, decreasing trends were noted for ESBL E. coli in both the community and LTC facilities and for ESBL K. pneumoniae in the community. The ESBL K. pneumoniae rates in LTC facilities continued to increase throughout the COVID-19 period. By subgroup analysis for different genders, age groups, and local health integration network (LHIN) units, similar trends were seen in most cases (P < 0.05), except for a few densely populated LHINs where rate changes were not statistically significant. IMPORTANCE Community-onset urinary tract infections (UTIs) caused by ESBL-producing Enterobacterales, particularly E. coli and K. pneumoniae, are a major public health concern. In this study, we assessed the impact of COVID-19 on ESBL rates in urine cultures in Ontario, Canada. Our results show the recent epidemiology of ESBL-producing Enterobacterales in urine cultures from both the community and LTC facilities in Ontario, Canada, and the impact of COVID-19 restrictions on ESBL trends for the entire province as well as different subgroups of the population based on demographic and geographic characteristics. Our results may have important public health implications in the context of the gradual easing of COVID-19 restrictions.

Evolution of Public Opinion on COVID-19 Vaccination in Japan: Large-Scale Twitter Data Analysis.

Vaccines are promising tools to control the spread of COVID-19. An effective vaccination campaign requires government policies and community engagement, sharing experiences for social support, and voicing concerns about vaccine safety and efficiency. The increasing use of online social platforms allows us to trace large-scale communication and infer public opinion in real time. This study aimed to identify the main themes in COVID-19 vaccine-related discussions on Twitter in Japan and track how the popularity of the tweeted themes evolved during the vaccination campaign. Furthermore, we aimed to understand the impact of critical social events on the popularity of the themes. We collected more than 100 million vaccine-related tweets written in Japanese and posted by 8 million users (approximately 6.4% of the Japanese population) from January 1 to October 31, 2021. We used Latent Dirichlet Allocation to perform automated topic modeling of tweet text during the vaccination campaign. In addition, we performed an interrupted time series regression analysis to evaluate the impact of 4 critical social events on public opinion. We identified 15 topics grouped into the following 4 themes: (1) personal issue, (2) breaking news, (3) politics, and (4) conspiracy and humor. The evolution of the popularity of themes revealed a shift in public opinion, with initial sharing of attention over personal issues (individual aspect), collecting information from news (knowledge acquisition), and government criticism to focusing on personal issues. Our analysis showed that the Tokyo Olympic Games affected public opinion more than other critical events but not the course of vaccination. Public opinion about politics was significantly affected by various social events, positively shifting attention in the early stages of the vaccination campaign and negatively shifting attention later. This study showed a striking shift in public interest in Japan, with users splitting their attention over various themes early in the vaccination campaign and then focusing only on personal issues, as trust in vaccines and policies increased. An interrupted time series regression analysis showed that the vaccination rollout to the general population (under 65 years) increased the popularity of tweets about practical advice and personal vaccination experience, and the Tokyo Olympic Games disrupted public opinion but not the course of the vaccination campaign. The methodology developed here allowed us to monitor the evolution of public opinion and evaluate the impact of social events on public opinion, using large-scale Twitter data.

Pregnancy outcomes in Italy during COVID-19 pandemic: a population-based cohort study.

To compare the estimates of preterm birth (PTB; 22-36 weeks gestational age, GA) and stillbirth rates during COVID-19 pandemic in Italy with those recorded in the three previous years. A population-based cohort study of liveborn and stillborn infants was conducted using data from Regional Health Systems and comparing the pandemic period (March 1st , 2020-March 31st , 2021, N= 362,129) to an historical period (January 2017- February 2020, N=1,117,172). The cohort covered 84.3% of the births in Italy. Poisson regressions were run in each Region and meta-analyses were performed centrally. We used an interrupted time series regression analysis to study the trend of preterm births from 2017 to 2021. The primary outcomes were PTB and stillbirths. Secondary outcomes were late PTB (32-36 weeks' GA), very PTB (<32 weeks' GA), and extremely PTB (<28 weeks' GA), overall and stratified into singleton and multiples. The pandemic period compared with the historical one was associated with a reduced risk for PTB (Risk Ratio: 0.91; 95% Confidence Interval, CI: 0.88, 0.93), late PTB (0.91; 0.88, 0.94), very PTB (0.88; 0.84, 0.91), and extremely PTB (0.88; 0.82, 0.95). In multiples, point estimates were not very different, but had wider CIs. No association was found for stillbirths (1.01; 0.90, 1.13). A linear decreasing trend in PTB rate was present in the historical period, with a further reduction after the lockdown. We demonstrated a decrease in PTB rate after the introduction of COVID-19 restriction measures, without an increase in stillbirths.

Effects of the Federal Aviation Administration's Compliance Program on aircraft incidents and accidents

• Restorative justice-based policies in aviation may be unsafe. • The FAA’s Compliance Program may reduce aviation safety. • Population-level data was evaluated using GLARMA modeling. • An increase in aircraft incidents and accidents resulted from the FAA’s Compliance Program. • A decrease in punishment may affect human behavioral responses. A novel enforcement policy based on restorative justice principles was implemented by the United States Federal Aviation Administration (FAA) in 2015. In this study, interrupted time series regression analyses using generalized linear autoregressive moving average (GLARMA) models were used to analyze FAA investigated incident and accident counts, runway incursion caused by pilot deviation, and National Transport Safety Board (NTSB) accident count data from June 2010 to September 2020. An association was observed between the change in FAA’s enforcement policy and the increase in aircraft incidents, accidents, and runway incursions post-intervention (2015–2020). These adverse safety outcomes appear to be directly related to this policy change. Results highlight the risk of moving away from punishment as a means of reinforcing safe behavior and the need for careful theory-based implementation of alternative approaches.

Effect of lung cancer screening on the incidence of advanced lung cancer in the United States: A SEER database analysis.

10506 Background: In 2013, the USPSTF recommended screening for lung cancer with low-dose chest computed tomography (LDCT). This was based on the results of the National Lung Screening Trial which showed a 20% relative reduction in mortality from LDCT compared with chest radiography. In Feb/March 2015, the Centers for Medicare and Medicaid (CMS) provided screening guidelines and they and private insurers started covering the cost of LDCT. The impact of this recommendation in the real-world setting is unknown. We investigated the impact of LDCT recommendations on the incidence of advanced lung cancer (a-LCa) in the US general population. We sought to verify that the implementation of LDCT will yield an earlier lung cancer diagnosis and thereby reduce the incidence of later stages of lung cancer. Methods: From the Surveillance, Epidemiology, and End Results (SEER) 18 registries database, we identified adults 55-80 years diagnosed with regional or metastatic (advanced) lung cancer from 2004 to 2018. Age-adjusted incidence rates (AAIR) of advanced lung cancer in 2004-2014 (Pre-LDCT) and 2015-2018 (Post-LDCT) were compared using interrupted time series (ITS) regression analyses. Analyses were stratified by sex, race, and residence. Results: A total of 400,343 patients who met the study criteria were included. Of these, 219,828 (55%) were women and 76% (n = 304,801) were non-Hispanic White. At all periods, the AAIR of a-LCa was highest in non-Hispanic Blacks. Overall, there was a 41% decline in the AAIR of a-LCa in the post-LDCT period compared to the pre-LDCT era (Annual decline of 7.6 vs 4.5 /100,000 person-years (PY) for 2015-2018 vs 2004-2014, p &lt; 0.01). Women experienced a more accelerated decline in the AAIR of a-LCa compared to men (53% versus 30%). By race, the annual rates of a-LCa declined most rapidly among non-Hispanic Blacks (55%, 9.5/ 100,000 PY, 2015-2018 vs 4.7/100,000 PY, 2004-2014, p &lt; 0.01), and the slowest rate of decline was among Hispanics (41%, 4.6/100,000 PY,2015-2018 vs 2.7/100,000 PY, 2004-2014, p &lt; 0.01). By residence, non-metropolitan dwellers experienced a greater decline in annual rates of a-LCa compared with metropolitan dwellers (non-Metropolitan: 69%, 10.1/100,000 PY, 2015-2018 vs 3.2/100,000 PY 2003-2014, p &lt; 0.01: Metropolitan dwellers: 37%, 7.2/100,000 PY 2015-2018 vs 4.5/100,000 PY, p &lt; 0.01). Conclusions: Using population-based data we found a significant decline in rates of a-LCa following the adoption of LDCT for lung cancer screening in the US. Rates of decline in the incidence of a-LCa, however, varied among subgroups. Non-Hispanic Blacks, women, and rural dwellers experienced the most decline in annual rates of a-LCa from 2015 to 2018. Our study shows the overall benefit of LDCT in marginalized communities. However, the impact of our findings on lung cancer mortality will still need further study.

Evaluating Oregon’s Justice Reinvestment Act: An Interrupted Time-Series Regression of State-Level Outcomes

Many jurisdictions across the U.S. have adopted justice reinvestment initiatives (JRIs) as a strategy for reducing the use of incarceration and mitigating large correctional budgets. In spite of this widespread adoption, little empirical research has explored the impacts of justice reinvestment policies. In response, this study employed quasiexperimental, interrupted time-series regression analyses using a decade of monthly court and corrections data to assess if JRI legislation in Oregon was effective. Results show decreased prison usage and recidivism, as well as reveal delayed and significant trend changes for felony jail admissions and community corrections populations as a result of the JRI legislations. A course for future research to further advance understanding of reinvestment and resource reallocation is outlined.

An Observational Study to Assess the Effectiveness of 4CMenB against Meningococcal Disease and Carriage and Gonorrhea in Adolescents in the Northern Territory, Australia-Study Protocol.

Invasive meningococcal disease (IMD) causes significant morbidity and mortality worldwide with serogroup B being the predominant serogroup in Australia and other countries for the past few decades. The licensed 4CMenB vaccine is effective in preventing meningococcal B disease. Emerging evidence suggests that although 4CMenB impact on carriage is limited, it may be effective against gonorrhoea due to genetic similarities between Neisseria meningitidis and Neisseria gonorrhoeae. This study protocol describes an observational study that will assess the effect of the 4CMenB vaccine against meningococcal carriage, IMD and gonorrhoea among adolescents in the Northern Territory (NT). All 14–19-year-olds residing in the NT with no contraindication for 4CMenB vaccine will be eligible to participate in this cohort study. Following consent, two doses of 4CMenB vaccine will be administered two months apart. An oropharyngeal swab will be collected at baseline and 12 months to detect pharyngeal carriage of Neisseria meningitidis by PCR. The main methodological approaches to assess the effect of 4CMenB involve a nested case control analysis and screening method to assess vaccine effectiveness and an Interrupted Time Series regression analysis to assess vaccine impact. Research ethics approvals have been obtained from Menzies and Central Australian Human Research Ethics Committees and the Western Australian Aboriginal Health Ethics Committee. Results will be provided in culturally appropriate formats for NT remote and regional communities and published in international peer reviewed journals. ClinicalTrials.gov Identifier: NCT04398849.

Impact of Education and Data Feedback on Antibiotic Prescribing for Urinary Tract Infections in the Emergency Department: An Interrupted Time-Series Analysis.

Urinary tract infections (UTIs) are often misdiagnosed or treated with exceedingly broad-spectrum antibiotics, leading to negative downstream effects. We aimed to implement antimicrobial stewardship (AS) strategies targeting UTI prescribing in the emergency department (ED). We conducted a quasi-experimental prospective AS intervention outlining appropriate UTI diagnosis and management across 3 EDs, within an academic and 2 community hospitals, in North Carolina, United States. The study was divided into 3 phases: a baseline period and 2 intervention phases. Phase 1 included introduction of an ED-specific urine antibiogram and UTI guideline, education, and department-specific feedback on UTI diagnosis and antibiotic prescribing. Phase 2 included re-education and provider-specific feedback. Eligible patients included adults with an antibiotic prescription for UTI diagnosed in the ED from 13 November 2018 to 1 March 2021. Admitted patients were excluded. The primary outcome was guideline-concordant antibiotic use, assessed using an interrupted time-series regression analysis with 2-week intervals. Overall, 8742 distinct patients with 10426 patient encounters were included. Ninety-two percent of all encounters (n = 9583) were diagnosed with cystitis and 8.1% with pyelonephritis (n = 843). There was an initial 15% increase in guideline-concordant antibiotic prescribing in phase 1 compared with the preintervention period (incidence rate ratio [IRR], 1.15; 95% confidence interval [CI], 1.03-1.29). A significant increase in guideline-concordant prescriptions was seen with every 2-week interval during phase 2 (IRR, 1.03; 95% CI, 1.01-1.04). This multifaceted AS intervention involving a guideline, education, and provider-specific feedback increased guideline-concordant antibiotic choices for treat-and-release patients in the ED.

Utilization and cost sharing for preventive cancer screenings

ObjectiveThe Patient Protection and Affordable Care Act (ACA) eliminated cost sharing for certain preventive cancer screenings beginning in September 2010. This paper examines the policy change’s impact on three preventive screenings, mammography, colonoscopy, and cervical screening, among commercially insured individuals. MethodsA retrospective longitudinal quasi-experimental design was utilized. Individuals in grandfathered plans were used as a comparison group because grandfathered plans are not subject to the preventive cost sharing benefit changes of the ACA. A multivariate logistic regression model matched individuals in treatment and comparison groups via propensity scoring. Monthly prevalence rates over the study period (2007–2014) were calculated as well as prevalence rates for the proportion of procedures with greater than 0 cost sharing. An interrupted time series regression analysis was conducted with the primary outcome variable the rate of preventive service utilization per person per month. ResultsThe overall trend in utilization of preventive mammography and cervical cancer screening slightly decreased as a result of the ACA cost sharing benefit policy change. There was a non-significant decrease for colonoscopy utilization as a result of the ACA policy change. ConclusionThe ACA’s cost benefit policy change is not having the desired impact of increasing preventive screening utilization. Further research is needed to determine whether providing educational materials covering the cost sharing benefit at policy enrollment might increase procedure uptake.

Impact of minimum unit pricing on alcohol purchases in Scotland and Wales: controlled interrupted time series analyses

As a policy option to reduce consumption of alcohol and the harm it does, on May 1, 2018, Scotland introduced a minimum price of 50 British pence (p) per unit of alcohol (8 g) sold; Wales followed suit on March 2, 2020, with the same minimum unit price (MUP). We analysed household purchase data based on bar codes to assess the impact of these policy options in the medium term for Scotland and in the immediate term for Wales. For these location-controlled, interrupted time series regression analyses, the data source was Kantar WorldPanel's household shopping panel, which, at the time of our analysis, included 35 242 British households providing detailed information on 1·24 million separate alcohol purchases in 2015-18 and the first half of 2020. With no data exclusions, we analysed the impact of introducing MUP in Scotland, using purchases in northern England as control, and in Wales, using western England as control. The studied changes associated with MUP were price paid per gram of alcohol purchased, grams of alcohol purchased, and amount of money spent on alcohol. In Scotland, price increases and purchase decreases following the introduction of MUP in 2018 were maintained during the first half of 2020. The difference between Scotland and northern England in 2020 was a price increase of 0·741 p per gram (95% CI 0·724-0·759), a 7·6% increase, and a purchase decrease of 7·063 g per adult per household per day that an alcohol purchase was made (6·656-7·470), a 7·7% decrease. In Wales, the introduction of MUP led to similar results. The difference between Wales and western England was a price increase 0·841 of 0·841 p per gram (0·732-0·951), an 8·2% increase, and a purchase decrease of 7·052 g per adult per household per day that an alcohol purchase was made (6·463-7·640), an 8·6% decrease. For both Scotland and Wales, reductions in overall purchases of alcohol were largely restricted to households that bought the most alcohol. The introduction of MUP was not associated with an increased expenditure on alcohol by households that generally bought small amounts of alcohol and, in particular, those with low incomes. The changes were not affected by the introduction of COVID-19 confinement in the UK on March 26, 2020. The evidence base supporting the positive, targeted impact of MUP is strengthened by the comparable results for Scotland and Wales. The short-term impact of MUP in Scotland during 2018 is maintained during the first half of 2020. MUP is an effective alcohol policy option to reduce off-trade purchases of alcohol and should be widely considered. None.