Natural Experiments to Inform Clinical Practice

AbstractNatural experiments refer to events or practices that result in similar individuals receiving different services or interventions for arbitrary reasons. In the clinical context, researchers may wish to leverage natural experiments to estimate the causal impact of a particular treatment on a health outcome in situations where randomized clinical trial data are unavailable and other observational research designs are likely to yield biased results. This review provides an overview of natural experiments, discusses the potential for natural experiments to establish cause and effect, illustrates applications to specific clinical questions, and outlines situations and practices where natural experiments are most likely to answer the question at hand. Overall, while natural experiments have become popular in health policy, the widespread application of these approaches to specific clinical questions faces several challenges.