Cruz Maricela, Ombao Hernando, Gillen Daniel L
Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
Biostatistics Group, King Abdullah University of Science and Technology Thuwal, Saudi Arabia.
Stat Biosci. 2022 Dec;14(3):582-610. doi: 10.1007/s12561-022-09346-6. Epub 2022 May 25.
Assessing the impact of complex interventions on measurable health outcomes is a growing concern in health care and health policy. Interrupted time series (ITS) designs borrow from traditional case-crossover designs and function as quasi-experimental methodology able to retrospectively analyze the impact of an intervention. Statistical models used to analyze ITS designs primarily focus on continuous-valued outcomes. We propose the "Generalized Robust ITS" (GRITS) model appropriate for outcomes whose underlying distribution belongs to the exponential family of distributions, thereby expanding the available methodology to adequately model binary and count responses. GRITS formally implements a test for the existence of a change point in discrete ITS. The methodology proposed is able to test for the existence of and estimate the change point, borrow information across units in multi-unit settings, and test for differences in the mean function and correlation pre- and post-intervention. The methodology is illustrated by analyzing patient falls from a hospital that implemented and evaluated a new care delivery model in multiple units.
评估复杂干预措施对可测量的健康结果的影响是医疗保健和卫生政策领域日益关注的问题。中断时间序列(ITS)设计借鉴了传统的病例交叉设计,作为一种准实验方法,能够回顾性分析干预措施的影响。用于分析ITS设计的统计模型主要关注连续值结果。我们提出了“广义稳健ITS”(GRITS)模型,适用于其潜在分布属于指数分布族的结果,从而扩展了可用方法,以充分模拟二元和计数响应。GRITS正式实现了对离散ITS中变化点存在性的检验。所提出的方法能够检验变化点的存在并估计变化点,在多单元设置中跨单元借用信息,并检验干预前后均值函数和相关性的差异。通过分析一家在多个单元实施并评估了新护理模式的医院的患者跌倒情况,对该方法进行了说明。