Medical Care

Skip Navigation LinksHome > June 2010 - Volume 48 - Issue 6 > Cluster Randomized Trials in Comparative Effectiveness Resea...
Medical Care:
doi: 10.1097/MLR.0b013e3181dbebcf
Comparative Effectiveness

Cluster Randomized Trials in Comparative Effectiveness Research: Randomizing Hospitals to Test Methods for Prevention of Healthcare-Associated Infections

Platt, Richard MD, MS*; Takvorian, Samuel U. AB*; Septimus, Edward MD†; Hickok, Jason MBA, RN†; Moody, Julia MS†; Perlin, Jonathan MD, PhD†; Jernigan, John A. MD, MS‡; Kleinman, Ken ScD*; Huang, Susan S. MD, MPH§

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Background: The need for evidence about the effectiveness of therapeutics and other medical practices has triggered new interest in methods for comparative effectiveness research.

Objective: Describe an approach to comparative effectiveness research involving cluster randomized trials in networks of hospitals, health plans, or medical practices with centralized administrative and informatics capabilities.

Research Design: We discuss the example of an ongoing cluster randomized trial to prevent methicillin-resistant Staphylococcus aureus (MRSA) infection in intensive care units (ICUs). The trial randomizes 45 hospitals to: (a) screening cultures of ICU admissions, followed by Contact Precautions if MRSA-positive, (b) screening cultures of ICU admissions followed by decolonization if MRSA-positive, or (c) universal decolonization of ICU admissions without screening.

Subjects: All admissions to adult ICUs.

Measures: The primary outcome is MRSA-positive clinical cultures occurring ≥2 days following ICU admission. Secondary outcomes include blood and urine infection caused by MRSA (and, separately, all pathogens), as well as the development of resistance to decolonizing agents.

Results: Recruitment of hospitals is complete. Data collection will end in Summer 2011.

Conclusions: This trial takes advantage of existing personnel, procedures, infrastructure, and information systems in a large integrated hospital network to conduct a low-cost evaluation of prevention strategies under usual practice conditions. This approach is applicable to many comparative effectiveness topics in both inpatient and ambulatory settings.

© 2010 Lippincott Williams & Wilkins, Inc.


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