Analyzing the impact of a state concussion law using an autoregressive integrated moving average intervention analysis
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(2020) 20:898
RESEARCH ARTICLE
Open Access
Analyzing the impact of a state concussion law using an autoregressive integrated moving average intervention analysis Lihong Huang1,2, Lindsay Sullivan2,3 and Jingzhen Yang2,4*
Abstract Background: Existing studies analyzing the impact of state concussion laws have found an increase in concussionrelated medical encounters post-law, in some instances, such increases were observed during the pre-law period due to a potential “spillover” effect. This study assessed the effects of Ohio’s concussion law, while accounting for such a “spillover” effect, on the trends in monthly rates of concussion-related medical encounters in Medicaid insured children using autoregressive integrated moving average (ARIMA) analysis. Methods: We analyzed claim data obtained from the Partners For Kids database, a pediatric accountable care organization in Ohio. Concussion-related medical encounters for Medicaid-insured children (ages 0–18 years) treated between April 1, 2008 to December 31, 2016 were selected and analyzed. We assessed pre- and post-law trends in concussion-related medical encounters using an ARIMA intervention model. We also used traditional regression methods to validate the study results. Results: A total of 16,943 concussion-related medical encounters sustained by 15,545 unique patients were included. Monthly rates of concussion-related medical encounters significantly increased from 4.64 per 10,000 member months during the pre-law period to 6.69 per 10,000 member months in the post-law period (P < 0.0001). Three upward breaks in the monthly rates of concussion-related medical encounters were observed between 2009 and 2016, with two breaks observed during the pre-law period. Specifically, the increased breakpoint observed in July 2011 (P = 0.0186) was significantly associated with an estimated 7.3% increase (95% CI: 1.1–13.7) in the rate of concussion-related medical encounters. This finding was confirmed in the Poisson regression and curve fitting models. Furthermore, a seasonal trend in concussion-related medical encounters was observed with the highest rates in September and October of each year. Conclusions: Two of the three upward breaks identified in the monthly rate of concussion-related medical encounters occurred before the enactment of Ohio’s concussion law, suggesting a potential “spillover” effect. Further research is needed to confirm such an effect in children with other types of medical insurance. Keywords: Concussion, Children, Intervention time series, ARIMA
* Correspondence: [email protected] 2 Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, RB3-WB5403, Columbus, OH 43205, USA 4 The Ohio State University, College of Medicine, Columbus, OH 43205, USA Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits
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