Interrupted Time Series for Assessing the Causality of Intervention Effects. Part 35 of a Series on Evaluating Scientific Publications.

IF 6.5 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Tim Mathes, Dominik Röding, Constance Stegbauer, Michael Laxy, Dawid Pieper
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Abstract

Background: The gold standard for evaluating interventions in medicine and health care is the randomized controlled trial (RCT). In practice, however, RCTs may be difficult to conduct because of high costs, ethical aspects, or practical considerations. This is particularly true of studies on the population level, e.g., for the evaluation of health policy measures.

Methods: We present a type of study design called the interrupted time series (ITS) and its critical interpretation, with several illustrative examples. This discussion is based on selected meth - odological publications.

Results: ITS are suitable for the assessment of interventions with a clear point of intervention (interruption). They are analyzed with the statistical methods of time-series analysis. One strength of ITS is that they can be used to estimate an immediate effect as well as a gradually developing effect. Under certain assumptions, the findings of an ITS analysis can be interpreted causally. The main assumption underlying an ITS is that the trend after the intervention would have been exactly the same as the trend before the intervention if the intervention had not taken place and all other conditions had remained unchanged. A further assumption is that there should be no differences in the pre- versus postintervention phases in the subjects or other entities being tested (e.g., hospitals) that might affect the measured endpoints (e.g., differences in mean age affecting measured mortality). Moreover, the intervention periods must be properly distinct from one another in order to prevent biased effect estimates. The robustness of the assumptions should also be checked with sensitivity analyses.

Conclusion: As long as all sources of bias have been avoided and the findings are both plausible and robust, the effects revealed by ITS can be interpreted as causal. ITS may serve as an alternative method for evaluating intervention effects when an RCT cannot be performed.

评估干预效果因果关系的中断时间序列。科学出版物评估系列第 35 部分。
背景:评估医疗和保健干预措施的黄金标准是随机对照试验(RCT)。然而,在实践中,由于成本高昂、伦理问题或实际考虑,随机对照试验可能难以开展。这一点在人口层面的研究中尤为明显,例如对卫生政策措施的评估:方法:我们介绍了一种称为间断时间序列(ITS)的研究设计及其重要解释,并列举了几个实例。本讨论基于部分方法论出版物:中断时间序列适用于评估有明确干预点(中断)的干预措施。它们采用时间序列分析的统计方法进行分析。ITS 的一个优点是可以用来估计即时效果和逐渐产生的效果。在某些假设条件下,ITS 的分析结果可按因果关系进行解释。ITS 的主要假设是,如果不采取干预措施,所有其他条件保持不变,则干预后的趋势与干预前的趋势完全相同。另一个假设是,受测者或其他受测实体(如医院)在干预前与干预后阶段不存在可能影响测量终点的差异(如影响测量死亡率的平均年龄差异)。此外,干预期之间必须适当区分,以防止效果估计出现偏差。还应通过敏感性分析检查假设的稳健性:结论:只要避免了所有的偏差来源,且研究结果可信且稳健,ITS 所揭示的效应就可以被解释为因果效应。在无法进行 RCT 的情况下,ITS 可以作为评估干预效果的替代方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Deutsches Arzteblatt international
Deutsches Arzteblatt international 医学-医学:内科
CiteScore
4.10
自引率
5.20%
发文量
306
审稿时长
4-8 weeks
期刊介绍: Deutsches Ärzteblatt International is a bilingual (German and English) weekly online journal that focuses on clinical medicine and public health. It serves as the official publication for both the German Medical Association and the National Association of Statutory Health Insurance Physicians. The journal is dedicated to publishing independent, peer-reviewed articles that cover a wide range of clinical medicine disciplines. It also features editorials and a dedicated section for scientific discussion, known as correspondence. The journal aims to provide valuable medical information to its international readership and offers insights into the German medical landscape. Since its launch in January 2008, Deutsches Ärzteblatt International has been recognized and included in several prestigious databases, which helps to ensure its content is accessible and credible to the global medical community. These databases include: Carelit CINAHL (Cumulative Index to Nursing and Allied Health Literature) Compendex DOAJ (Directory of Open Access Journals) EMBASE (Excerpta Medica database) EMNursing GEOBASE (Geoscience & Environmental Data) HINARI (Health InterNetwork Access to Research Initiative) Index Copernicus Medline (MEDLARS Online) Medpilot PsycINFO (Psychological Information Database) Science Citation Index Expanded Scopus By being indexed in these databases, Deutsches Ärzteblatt International's articles are made available to researchers, clinicians, and healthcare professionals worldwide, contributing to the global exchange of medical knowledge and research.
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