| Estimating the population impact of preventive interventions from randomized trials. | |
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MedLine Citation:
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PMID: 21238868 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Growing concern about the limited generalizability of trials of preventive interventions has led to several proposals concerning the design, reporting, and interpretation of such trials. This paper presents an epidemiologic framework that highlights three key determinants of population impact of many prevention programs: the proportion of the population at risk who would be candidates for a generic intervention in routine use, the proportion of those candidates who are actually intervened on through a specific program, and the reduction in incidence produced by that program among recipients. It then describes how the design of a prevention trial relates to estimating these quantities. Implications of the framework include the following: (1) reach is an attribute of a program, whereas external validity is an attribute of a trial, and the two should not be conflated; (2) specification of a defined target population at risk is essential in the long run and merits greater emphasis in the planning and interpretation of prevention trials; (3) with due attention to sampling frame and sampling method, the process of subject recruitment for a trial can yield key information about quantities that are important for assessing its potential population impact; and (4) exclusions during subject recruitment can be conceptually separated into intervention-driven, program-driven, and trial-design-driven exclusions, which have quite different implications for trial interpretation and for estimating population impact of the intervention studied. |
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Authors:
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Thomas D Koepsell; Douglas F Zatzick; Frederick P Rivara |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: American journal of preventive medicine Volume: 40 ISSN: 1873-2607 ISO Abbreviation: Am J Prev Med Publication Date: 2011 Feb |
Date Detail:
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Created Date: 2011-01-17 Completed Date: 2011-04-29 Revised Date: 2012-03-26 |
Medline Journal Info:
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Nlm Unique ID: 8704773 Medline TA: Am J Prev Med Country: Netherlands |
Other Details:
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Languages: eng Pagination: 191-8 Citation Subset: IM |
Copyright Information:
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Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA. koepsell@u.washington.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Data Interpretation, Statistical Epidemiologic Research Design* Humans Models, Theoretical Preventive Medicine* Randomized Controlled Trials as Topic* |
| Grant Support | |
ID/Acronym/Agency:
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K24 MH086814-02/MH/NIMH NIH HHS; K24/MH086814/MH/NIMH NIH HHS; R01 MH073613-05/MH/NIMH NIH HHS; R01/MH073613/MH/NIMH NIH HHS; R49/CE000197/CE/NCIPC CDC HHS |
| Comments/Corrections | |
Comment In:
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Am J Prev Med. 2012 Mar;42(3):e30-1; author reply e31-2
[PMID:
22341177
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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