Fretheim, A, Zhang, F, Ross-Degnan, D et al. (9 more authors) (2015) A reanalysis of cluster randomized trials showed interrupted time-series studies were valuable in health system evaluation. Journal of Clinical Epidemiology, 68 (3). 324 - 333. ISSN 0895-4356
Abstract
Objectives There is often substantial uncertainty about the impacts of health system and policy interventions. Despite that, randomized controlled trials (RCTs) are uncommon in this field, partly because experiments can be difficult to carry out. An alternative method for impact evaluation is the interrupted time-series (ITS) design. Little is known, however, about how results from the two methods compare. Our aim was to explore whether ITS studies yield results that differ from those of randomized trials. Study Design and Setting We conducted single-arm ITS analyses (segmented regression) based on data from the intervention arm of cluster randomized trials (C-RCTs), that is, discarding control arm data. Secondarily, we included the control group data in the analyses, by subtracting control group data points from intervention group data points, thereby constructing a time series representing the difference between the intervention and control groups. We compared the results from the single-arm and controlled ITS analyses with results based on conventional aggregated analyses of trial data. Results The findings were largely concordant, yielding effect estimates with overlapping 95% confidence intervals (CI) across different analytical methods. However, our analyses revealed the importance of a concurrent control group and of taking baseline and follow-up trends into account in the analysis of C-RCTs. Conclusion The ITS design is valuable for evaluation of health systems interventions, both when RCTs are not feasible and in the analysis and interpretation of data from C-RCTs.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2014 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/). |
Keywords: | Evaluation methods; Randomized trials; Interrupted time-series; Quasi-experimental design; Impact evaluations; Health services research |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds) > Academic Unit of Primary Care (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 08 Oct 2015 11:47 |
Last Modified: | 01 Mar 2019 12:34 |
Published Version: | http://dx.doi.org/10.1016/j.jclinepi.2014.10.003 |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/j.jclinepi.2014.10.003 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:86553 |
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