Healthy User and Related Biases in Observational Studies of Preventive Interventions: A Primer for Physicians

摘要: The current emphasis on comparative effectiveness research will provide practicing physicians with increasing volumes of observational evidence about preventive care. However, numerous highly publicized studies the effect prevention health outcomes have reported exaggerated relationships that were later contradicted by randomized controlled trials. A growing body has identified sources bias in are related to patient behaviors or underlying characteristics, known as healthy user effect, adherer confounding functional status cognitive impairment, and selective prescribing. In this manuscript we briefly review appeared reach incorrect conclusions. We then describe potential these discuss study designs, analytical methods, sensitivity analyses may mitigate increase confidence results reported. More careful consideration designs providers can enhance evidence-based decision-making.