Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/135177
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Type: Journal article
Title: Emulating a target trial of intensive nurse home visiting in the policy-relevant population using linked administrative data
Author: Moreno-Betancur, M.
Lynch, J.W.
Pilkington, R.M.
Schuch, H.S.
Gialamas, A.
Sawyer, M.G.
Chittleborough, C.R.
Schurer, S.
Gurrin, L.C.
Citation: International Journal of Epidemiology, 2023; 52(1):119-131
Publisher: Oxford University Press (OUP)
Issue Date: 2023
ISSN: 0300-5771
1464-3685
Statement of
Responsibility: 
Margarita Moreno-Betancur, JohnW. Lynch, Rhiannon M. Pilkington, Helena S. Schuch, Angela Gialamas, Michael G. Sawyer, Catherine R. Chittleborough, Stefanie Schurer, and Lyle C. Gurrin
Abstract: Background: Populations willing to participate in randomized trials may not correspond well to policy-relevant target populations. Evidence of effectiveness that is complementary to randomized trials may be obtained by combining the ‘target trial’ causal inference framework with whole-of-population linked administrative data. Methods: We demonstrate this approach in an evaluation of the South Australian Family Home Visiting Program, a nurse home visiting programme targeting socially disadvantaged families. Using de-identified data from 2004–10 in the ethics-approved Better Evidence Better Outcomes Linked Data (BEBOLD) platform, we characterized the policy-relevant population and emulated a trial evaluating effects on child developmental vulnerability at 5years (n¼4160) and academic achievement at 9 years (n¼6370). Linkage to seven health, welfare and education data sources allowed adjustment for 29 confounders using Targeted Maximum Likelihood Estimation (TMLE) with SuperLearner. Sensitivity analyses assessed robustness to analytical choices. Results: We demonstrated how the target trial framework may be used with linked administrative data to generate evidence for an intervention as it is delivered in practice in the community in the policy-relevant target population, and considering effects on VC outcomes years down the track. The target trial lens also aided in understanding and limiting the increased measurement, confounding and selection bias risks arising with such data. Substantively, we did not find robust evidence of a meaningful beneficial intervention effect. Conclusions: This approach could be a valuable avenue for generating high-quality, policy-relevant evidence that is complementary to trials, particularly when the target populations are multiply disadvantaged and less likely to participate in trials.
Keywords: Causal inference
generalizability
linked data
nurse visiting programme
social disadvantage
target trial
targeted maximum likelihood estimation
transportability
Description: Advance Access Publication Date: 18 May 2022
Rights: © The Author(s) 2022. Published by Oxford University Press on behalf of the International Epidemiological Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
DOI: 10.1093/ije/dyac092
Grant ID: http://purl.org/au-research/grants/nhmrc/1099422
http://purl.org/au-research/grants/arc/DE190101326
Published version: http://dx.doi.org/10.1093/ije/dyac092
Appears in Collections:Public Health publications

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