A comparison of methods for health policy evaluation with controlled pre-post designs
A comparison of methods for health policy evaluation with controlled pre-post designs
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DOI：
10.1111/1475-6773.13274
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发表时间：
2020-02-12
影响因子：
3.4
通讯作者：
Grieve, Richard
中科院分区：
文献类型：
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作者：
O'Neill, Stephen;Kreif, Noemi;Grieve, Richard
目的比较交互式固定效应（IFE）和广义综合控制（GSC）方法与卫生政策评估中流行的方法，并重新评估2010年英国医院引入的髋部骨折最佳实践关税的影响。数据来源模拟和医院事件统计。研究设计最佳实践关税旨在激励提供者按照指南提供护理。根据该计划，62名提供者在每次髋部骨折入院时获得额外付款，而49名提供者没有。我们使用差异中的差异（DiD），合成控制（SC），IFE和GSC方法估计影响。我们对比的估计方法的性能在Monte Carlo模拟study.Principal调查结果不同的DiD，SC和IFE方法，GSC方法提供了可靠的估计在一系列的模拟场景，并首选本案例研究。最佳实践关税的引入导致了5.9（置信区间：2.0至9.9）个百分点的增加，在48小时内手术的患者比例和统计学上不显著的0.6（置信区间：-1.4至0.4）个百分点的减少30天mortality.Conclusions的GSC方法是一个有吸引力的方法，卫生政策评估。我们不能确信最佳做法关税是有效的。
Objective To compare interactive fixed effects (IFE) and generalized synthetic control (GSC) methods to methods prevalent in health policy evaluation and re-evaluate the impact of the hip fracture best practice tariffs introduced for hospitals in England in 2010.Data Sources Simulations and Hospital Episode Statistics.Study Design Best practice tariffs aimed to incentivize providers to deliver care in line with guidelines. Under the scheme, 62 providers received an additional payment for each hip fracture admission, while 49 providers did not. We estimate the impact using difference-in-differences (DiD), synthetic control (SC), IFE, and GSC methods. We contrast the estimation methods' performance in a Monte Carlo simulation study.Principal Findings Unlike DiD, SC, and IFE methods, the GSC method provided reliable estimates across a range of simulation scenarios and was preferred for this case study. The introduction of best practice tariffs led to a 5.9 (confidence interval: 2.0 to 9.9) percentage point increase in the proportion of patients having surgery within 48 hours and a statistically insignificant 0.6 (confidence interval: -1.4 to 0.4) percentage point reduction in 30-day mortality.Conclusions The GSC approach is an attractive method for health policy evaluation. We cannot be confident that best practice tariffs were effective.