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Study design elements for rigorous quasi-experimental comparative effectiveness research.

Matthew L Maciejewski1, Lesley H Curtis, Bryan Dowd

  • 1Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA. mlm34@duke.edu.

Journal of Comparative Effectiveness Research
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Rigorous quasi-experiments offer feasible, affordable, and externally valid evidence for comparative treatment effectiveness. Addressing discordance and enhancing internal validity are crucial for informing clinical and policy decisions.

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Area of Science:

  • Health Services Research
  • Biostatistics
  • Epidemiology

Background:

  • Randomized trials are the gold standard but often infeasible for comparative effectiveness research.
  • Quasi-experimental designs offer practical advantages like feasibility, timeliness, affordability, and external validity.
  • There is an ongoing debate regarding the evidentiary value of quasi-experiments compared to randomized trials.

Purpose of the Study:

  • To review potential sources of discordance between quasi-experimental and experimental study results.
  • To examine study design choices that can enhance the internal validity of quasi-experiments.
  • To outline innovative data linkage strategies for quasi-experimental comparative effectiveness research.

Main Methods:

  • This is a review article, synthesizing existing literature and methodologies.
  • It discusses theoretical sources of bias and proposes design improvements.
  • It highlights the utility of advanced data linkage techniques.

Main Results:

  • Potential discordance between quasi-experiments and randomized trials can arise from various sources.
  • Specific study design choices can significantly improve the internal validity of quasi-experiments.
  • Innovative data linkage strategies can strengthen the evidence base from quasi-experiments.

Conclusions:

  • Quasi-experiments are essential for generating comparative effectiveness evidence due to their practical advantages.
  • Improving the internal validity and addressing discordance are key to maximizing their utility.
  • Greater consideration of rigorous quasi-experiments is needed for robust clinical and policy decision-making.