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Instrumental variable methods for effectiveness research

Many research questions, such as quality of specific providers or guideline‐concordant care in typical practices, are commonly studied in an observational setting. These analyses face the risk that covariates related to both an outcome of interest and the probability of treatment are unobserved or uncontrolled. The resulting biases can easily overwhelm true effects or create apparent effects, and small changes in the analytic approach can yield contradictory results, which is demonstrated for antidepressant medication and counselling.