Healthy User and Related Biases in Observational Studies of Preventive Interventions: A Primer for Physicians
Healthy User and Related Biases in Observational Studies of Preventive Interventions: A Primer for Physicians
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DOI：
10.1007/s11606-010-1609-1
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发表时间：
2011-05-01
影响因子：
5.7
通讯作者：
Brookhart, M. Alan
中科院分区：
文献类型：
--
作者：
Shrank, William H.;Patrick, Amanda R.;Brookhart, M. Alan
目前对比较有效性研究的重视将为执业医师提供越来越多的关于预防保健的观察证据。然而，许多关于预防对健康结果影响的高度宣传的观察性研究报告了夸大的关系，后来被随机对照试验所反驳。越来越多的研究已经确定了观察性研究中与患者行为或潜在患者特征相关的偏倚来源，称为健康使用者效应、健康依从者效应、功能状态或认知障碍的混淆以及选择性处方的混淆。在本文中，我们简要回顾了似乎得出错误结论的预防观察性研究。然后，我们描述了这些研究中潜在的偏倚来源，并讨论了可能减轻偏倚或增加报告结果置信度的研究设计、分析方法和敏感性分析。提供者更仔细地考虑这些偏见来源和研究设计可以加强循证决策。
The current emphasis on comparative effectiveness research will provide practicing physicians with increasing volumes of observational evidence about preventive care. However, numerous highly publicized observational studies of the effect of prevention on health outcomes have reported exaggerated relationships that were later contradicted by randomized controlled trials. A growing body of research has identified sources of bias in observational studies that are related to patient behaviors or underlying patient characteristics, known as the healthy user effect, the healthy adherer effect, confounding by functional status or cognitive impairment, and confounding by selective prescribing. In this manuscript we briefly review observational studies of prevention that have appeared to reach incorrect conclusions. We then describe potential sources of bias in these studies and discuss study designs, analytical methods, and sensitivity analyses that may mitigate bias or increase confidence in the results reported. More careful consideration of these sources of bias and study designs by providers can enhance evidence-based decision-making.