The use of interrupted time series for the evaluation of public health interventions
The use of interrupted time series for the evaluation of public health interventions
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DOI：
10.17037/pubs.04648680
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发表时间：
2018-07
期刊：
影响因子：
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通讯作者：
James Andrés López;A. Gasparrini;S. Cummins;Stephen B. Soumerai;Martin J. McKee
中科院分区：
文献类型：
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作者：
James Andrés López;A. Gasparrini;S. Cummins;Stephen B. Soumerai;Martin J. McKee
需要对公共卫生干预措施进行强有力的评估，以确保采取能带来最大健康效益的干预措施。然而，传统的实验评价设计很少适用于公共卫生评价。此外，另一种“准实验”设计未得到充分利用，在流行病学课程中很少详细介绍，并且被排除在许多指南和评论之外。因此，人口水平的卫生干预措施遭受了“评价偏差”，即不适合随机对照试验的干预措施往往要么评价不佳，要么根本不评价。中断时间序列（ITS）分析是评估人群水平健康干预措施有效性的最有力的准实验设计之一。它越来越多地被用于评估从临床指南到国家公共卫生立法等各种干预措施的有效性。基本设计包括比较干预前后的兴趣结果，同时考虑任何潜在趋势。然而，ITS研究，像其他准实验一样，对其内部有效性的内在威胁比实验设计更多，其中许多在现有文献中没有得到充分的解决。需要就这些威胁以及如何在ITS研究的设计、应用和评估中最好地解决这些威胁提供进一步的指导。本论文的总体目标是改进公共卫生干预措施的中断时间序列研究的设计方式，以减少偏倚风险，并使公共卫生干预措施的评估者更容易获得稳健的ITS设计。这将通过使用ITS设计的一系列方法和应用研究来实现。
Robust evaluation of public health interventions is required to ensure that interventions that lead to the greatest health benefit are adopted. However, traditional experimental evaluative designs are rarely possible for public health evaluation. Furthermore, alternative “quasi-experimental” designs are underused, are seldom covered in detail in epidemiology courses and are excluded from many guidelines and reviews. As a result population level health interventions have suffered from an “evaluative bias” whereby interventions not amenable to randomised control trials are often either poorly evaluated or not evaluated at all. Interrupted time series (ITS) analysis is one of the most powerful quasi-experimental designs for evaluating the effectiveness of population level health interventions. It is increasingly being used to evaluate the effectiveness of interventions ranging from clinical guidelines to national public health legislation. The basic design involves comparing the outcome of interest before and after an intervention, whilst accounting for any underlying trend. Nevertheless, ITS studies, like other quasiexperiments have more inherent threats to their internal validity than experimental designs, many of which have not been adequately addressed in the existing literature. Further guidance is needed on these threats and how they are best addressed in the design, application and appraisal of ITS studies. The overarching aims of this thesis are to improve the way that interrupted time series studies of public health interventions are designed in order to reduce the risk of bias and to make robust ITS designs more accessible to evaluators of public health interventions. This will be achieved through a range of methodological and applied studies using ITS designs.