Evidence-based public health: Moving beyond randomized trials
Evidence-based public health: Moving beyond randomized trials
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DOI：
10.2105/ajph.94.3.400
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发表时间：
2004-03-01
影响因子：
12.7
通讯作者：
Bryce, J
中科院分区：
文献类型：
--
作者：
Victora, CG;Habicht, JP;Bryce, J
随机对照试验（rct）对于评估临床干预措施的疗效至关重要，其中药物和结果之间的因果链相对较短且简单，并且结果可以安全地外推到其他情况。然而，公共卫生干预措施的因果链是复杂的，这使得随机对照试验的结果在不同人群中可能会发生效果改变。RCT结果的内部和外部有效性都可以通过采用充分性或合理性设计的观察性研究大大提高。对于评估大规模干预措施，具有合理性设计的研究通常是唯一可行的选择，并且可以提供有效的影响证据。在不适合随机对照试验的情况下，迫切需要制定评估标准和方案。
Randomized controlled trials (RCTs) are essential for evaluating the efficacy of clinical interventions, where the causal chain between the agent and the outcome is relatively short and simple and where results may be safely extrapolated to other settings.However, causal chains in public health interventions are complex, making RCT results subject to effect modification in different populations. Both the internal and external validity of RCT findings can be greatly enhanced by observational studies using adequacy or plausibility designs. For evaluating large-scale interventions, studies with plausibility designs are often the only feasible option and may provide valid evidence of impact.There is an urgent need to develop evaluation standards and protocols for use in circumstances where RCTs are not appropriate.