The application of interrupted time series designs for the evaluation of public health interventions

这项研究的背景是什么？公共卫生干预措施(如吸烟立法、健康促进计划和卫生服务改革)通常适用于整个人口，而不是个人。通常，这意味着评估干预是否有效的传统方法，如新药的临床试验，不能应用。这导致缺乏关于哪些公共卫生干预措施在改善健康方面最有效的知识，导致不适当的资源分配，良好的干预措施没有得到实施，而糟糕的干预措施仍在继续。一种评估干预措施的有效方法是中断时间序列(ITS)分析，该方法经常用于其他领域，如经济学、政策研究和教育研究，但在卫生研究中较少使用。基本原则是比较干预前后一段时间内的利息结果，同时考虑任何潜在的趋势。在公共卫生的背景下进一步发展这一方法将使得对复杂的公共卫生干预措施进行更稳健的评估。如果有的话，这项研究与哪种疾病(S)/病情(S)相关？这项研究与所有人群水平的健康干预措施以及一些不适合临床试验的个人水平的健康干预措施的评估有关。本研究试图达到什么目的？本项目旨在输出和发展ITS技术，作为评估公共卫生干预措施有效性的稳健方法，将该方法应用于现实生活中的公共卫生干预措施的评估，并就其方法在该领域的适当使用制定全面的指导方针。为什么这一点很重要？这项研究将帮助我们准确地评估人口水平的卫生干预措施，否则将难以评估。这对于确保最高质量的干预措施在实践中得到最大的健康收益是很重要的。谁在进行这项研究？詹姆斯·洛佩兹·伯纳尔博士(公共卫生学术临床研究员)将为他在伦敦卫生和热带医学院的博士学位进行这项研究。他将由公共卫生干预评估专家Steven Cummins教授(人口健康教授)和Antionio Gasparrini博士(生物统计学和流行病学讲师)监督，他的主要研究重点是时间序列分析。这项研究还将涉及与哈佛大学人口医学系的合作。这项研究是如何进行的？1)将对其他学科关于其方法的现有知识进行整理和审查，以了解哪些方法可以直接适用于公共卫生干预，以及哪里可能存在差异。然后将审查其发表的公共卫生干预研究，以评估所使用的具体设计和分析方法以及由此产生的任何方法学问题。2)将进行至少两个案例研究，其中将使用其设计来评估现实生活中公共卫生干预的有效性，包括：-评估工作场所健康和福利方案对雇员健康不良的影响。-评估在NHS中转向由全科医生领导的服务对转诊到专科医院护理的影响。3)将通过开发技术以提高ITS方法的稳健性和准确性并在案例研究中测试这些技术来解决在项目早期阶段发现的问题。4)将利用在这项研究中获得的知识和经验，制定关于适当使用其设计来评估公共卫生干预措施的指导方针。

What is the context of the research?Public health interventions (such as smoking legislation, health promotion programmes and health service changes) are generally applied to whole populations rather than individuals. Often, this means that traditional methods for evaluating whether an intervention works, such as a clinical trial for a new drug, cannot be applied. This results in a lack of knowledge about which public health interventions are most effective at improving health, resulting in inappropriate resource allocation with good interventions not being implemented and poor interventions being continued. One powerful method to evaluate interventions, which is frequently used in other fields such as economics, policy research and education research, but less commonly in health research, is interrupted time series (ITS) analysis. The basic principle is to compare the outcome of interest over time before and after an intervention whilst taking into account any underlying trends. Further development of this method in the context of public health will enable more robust evaluation of complex public health interventions.To which disease(s)/ condition(s), if any, is the research relevant?This research is relevant to the evaluation of all population level health interventions as well as some individual level health interventions which are not amenable to clinical trials.What is the research trying to achieve?This project aims to export and develop the ITS technique as a robust method to evaluate the effectiveness of public health interventions, implement the method in the evaluation of real life public health interventions and develop comprehensive guidelines on the appropriate usage of ITS methods in this field.Why is this important?This research will help us to accurately evaluate population level health interventions that would otherwise be difficult to evaluate. This is important for ensuring that the highest quality interventions which lead to the greatest health gains are implemented in practice.Who is carrying out the research?Dr James Lopez Bernal (Academic Clinical Fellow in Public Health) will be conducting this research for his PhD at the London School of Hygiene and Tropical Medicine. He will be supervised by Professor Steven Cummins (Professor of Population Health) who is an expert in the evaluation of public health interventions, and Dr Antionio Gasparrini (Lecturer in Biostatistics and Epidemiology) whose main research focus lies in time series analysis. The research will also involve collaboration with the Department of Population Medicine at Harvard University.How is the research being conducted?1) Existing knowledge on ITS methods from other disciplines will be collated and reviewed in order to understand where methods may be directly applicable to public health interventions and where there may be differences. Published ITS studies of public health interventions will then be reviewed in order to evaluate specific designs and analytical methods used and any methodological issues arising from them.2) At least two case studies will be conducted in which an ITS design will be used to evaluate the effectiveness of real life public health interventions, including:- Evaluation of the effect of a workplace health and wellbeing programme on ill health among employees.- Evaluation of the effect of the move to GP led commissioning of services in the NHS on referrals to specialist hospital care.3) Issues identified during the earlier stages of the project will be addressed by developing techniques to improve the robustness and accuracy of the ITS method and testing these on the case studies.4) The knowledge and experience gained during this research will be used to develop guidelines on the appropriate use of ITS designs for the evaluation of public health interventions.