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Noninterventional studies in the COVID-19 era: methodological considerations for study design and analysis

The global COVID-19 pandemic has generated enormous morbidity and mortality, as well as large health system disruptions including changes in use of prescription medications, outpatient encounters, emergency department admissions, and hospitalizations. These pandemic-related disruptions are reflected...

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Published in:Journal of clinical epidemiology 2023-01, Vol.153, p.91-101
Main Authors: Butler, Anne M., Burcu, Mehmet, Christian, Jennifer B., Tian, Fang, Andersen, Kathleen M., Blumentals, William A., Joynt Maddox, Karen E., Alexander, G. Caleb
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description The global COVID-19 pandemic has generated enormous morbidity and mortality, as well as large health system disruptions including changes in use of prescription medications, outpatient encounters, emergency department admissions, and hospitalizations. These pandemic-related disruptions are reflected in real-world data derived from electronic medical records, administrative claims, disease or medication registries, and mobile devices. We discuss how pandemic-related disruptions in healthcare utilization may impact the conduct of noninterventional studies designed to characterize the utilization and estimate the effects of medical interventions on health-related outcomes. Using hypothetical studies, we highlight consequences that the pandemic may have on study design elements including participant selection and ascertainment of exposures, outcomes, and covariates. We discuss the implications of these pandemic-related disruptions on possible threats to external validity (participant selection) and internal validity (for example, confounding, selection bias, missing data bias). These concerns may be amplified in populations disproportionately impacted by COVID-19, such as racial/ethnic minorities, rural residents, or people experiencing poverty. We propose a general framework for researchers to carefully consider during the design and analysis of noninterventional studies that use real-world data from the COVID-19 era.
doi_str_mv 10.1016/j.jclinepi.2022.11.011
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subjects Antibiotics
Bias
COVID-19
COVID-19 - epidemiology
Data analysis
Design
Design analysis
Electronic devices
Electronic health records
Electronic medical records
Emergency medical care
Emergency medical services
Epidemiology
Health services utilization
Hospitalization
Humans
Medicaid
Medical research
Methodology
Minority & ethnic groups
Missing data
Morbidity
Pandemics
Patients
Poverty
Prescription drugs
Real-world data
Real-world evidence
Research Design
Rural populations
Study design
Telemedicine
Urinary tract infections
Validity
title Noninterventional studies in the COVID-19 era: methodological considerations for study design and analysis
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