Use of interrupted time series methods in the evaluation of health system quality improvement interventions: a methodological systematic review.
Use of interrupted time series methods in the evaluation of health system quality improvement interventions: a methodological systematic review.
复制标题
DOI：
10.1136/bmjgh-2020-003567
复制
发表时间：
2020-10
影响因子：
8.1
通讯作者：
Law MR
中科院分区：
文献类型：
--
作者：
Hategeka C;Ruton H;Karamouzian M;Lynd LD;Law MR
当随机化是不可能的，中断时间序列（ITS）设计越来越多地被提倡作为一个更强大的设计，以评估卫生系统质量改善（QI）干预措施，因为它能够控制常见的偏见，在医疗保健QI。然而，当这种相当稳健的设计没有得到适当的使用时，存在产生误导性结果的潜在风险。我们对文献进行了方法学系统回顾，以调查ITS的使用在何种程度上遵循了QI干预评估的最佳实践标准和建议。我们检索了从成立到2018年6月的多个数据库，以确定使用ITS评估的QI干预研究。对日期、语言和参与者没有限制。使用适当的描述性统计量对数据进行叙述性合成。使用科克伦有效实践和护理组织标准评估ITS研究的偏倚风险。系统评价方案已在PROSPERO注册（注册号：CRD 42018094427）。在筛选纳入的4061项潜在研究和2028项独特记录中，120项合格研究评估了8种QI策略，来自25个国家。大多数研究自2010年以来发表（86.7%），使用每月间隔报告数据（71.4%），使用无对照的ITS（81%）和使用分段回归建模数据（62.5%）。55%的研究考虑了自相关性，20.8%考虑了季节性，8.3%考虑了非平稳性。只有49.2%的研究指定了ITS影响模型。72.5%的纳入研究的偏倚风险为高或非常高，且随时间推移无显著变化。在过去十年中，ITS在评估卫生系统QI干预措施中的使用大大增加。然而，在方法上的考虑和报告的ITS在QI的变化仍然是一个问题，需要制定和加强正式的报告指南，以改善其在评估卫生系统QI干预措施的应用。
When randomisation is not possible, interrupted time series (ITS) design has increasingly been advocated as a more robust design to evaluating health system quality improvement (QI) interventions given its ability to control for common biases in healthcare QI. However, there is a potential risk of producing misleading results when this rather robust design is not used appropriately. We performed a methodological systematic review of the literature to investigate the extent to which the use of ITS has followed best practice standards and recommendations in the evaluation of QI interventions. We searched multiple databases from inception to June 2018 to identify QI intervention studies that were evaluated using ITS. There was no restriction on date, language and participants. Data were synthesised narratively using appropriate descriptive statistics. The risk of bias for ITS studies was assessed using the Cochrane Effective Practice and Organisation of Care standard criteria. The systematic review protocol was registered in PROSPERO (registration number: CRD42018094427). Of 4061 potential studies and 2028 unique records screened for inclusion, 120 eligible studies assessed eight QI strategies and were from 25 countries. Most studies were published since 2010 (86.7%), reported data using monthly interval (71.4%), used ITS without a control (81%) and modelled data using segmented regression (62.5%). Autocorrelation was considered in 55% of studies, seasonality in 20.8% and non-stationarity in 8.3%. Only 49.2% of studies specified the ITS impact model. The risk of bias was high or very high in 72.5% of included studies and did not change significantly over time. The use of ITS in the evaluation of health system QI interventions has increased considerably over the past decade. However, variations in methodological considerations and reporting of ITS in QI remain a concern, warranting a need to develop and reinforce formal reporting guidelines to improve its application in the evaluation of health system QI interventions.
登录
查看更多内容
肯尼亚锡卡医院改变外科抗生素预防的使用：采用间断时间序列设计的质量改进干预措施。
影响因子：
3.7
作者：
Aiken AM;Wanyoro AK;Mwangi J;Juma F;Mugoya IK;Scott JA
通讯作者：
Scott JA
影响因子：
5.2
作者：
Charani, E.;Gharbi, M.;Holmes, A. H.
通讯作者：
Holmes, A. H.
影响因子：
4.5
作者：
Barker, Anna K.;Krasity, Benjamin;Safdar, Nasia
通讯作者：
Safdar, Nasia
影响因子：
--
作者：
Brown, P.;Ryan, R.;van der Meulen (chair), J.
通讯作者：
van der Meulen (chair), J.
影响因子：
5.4
作者：
Andersen, Stig Ejdrup;Knudsen, Jenny Dahl
通讯作者：
Knudsen, Jenny Dahl