17 - A Brief Introduction to Causal Inference in Healthcare

Summary

This chapter focuses on causal inference in healthcare, emphasizing the need to identify causal relationships in data to answer important questions related to efficacy, mortality, productivity, and care delivery models. The authors discuss the limitations of randomized controlled trials due to ethical or pragmatic considerations and introduce quasi-experimental research designs as a scientifically coherent alternative. They divide these designs into two broad categories, independence-based designs and model-based designs, and explain the validity of assumptions necessary for each design. The chapter covers key concepts such as potential outcomes, selection bias, heterogeneous treatment effects bias, average treatment effect, average treatment effect for the treated and untreated, and local average treatment effect. Additionally, it discusses important quasi-experimental designs such as regression discontinuity, difference-in-differences, and synthetic controls. The chapter concludes by highlighting the importance of careful selection and application of these methods to estimate causal effects accurately and open the black box of healthcare.