Cluster Randomized Trials for the Evaluation of Strategies Designed to Promote Evidence-Based Practice in Perinatal and Neonatal Medicine

Cluster Randomized Trials for the Evaluation of Strategies Designed to Promote Evidence-Based Practice in Perinatal and Neonatal Medicine

This article makes a case for cluster-randomized trials to encourage evidence-based practice in medical care. The case rests on theoretical, empirical, and methodological grounds. To illustrate, we describe two recent studies. The first trial, with participation by 27 tertiary care hospitals, concer...

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Bibliographic Details
Published in:The Annals of the American Academy of Political and Social Science 2005-05, Vol.599 (1), p.94-114
Main Authors: Leviton, Laura C., Horbar, Jeffrey D.
Format: Article
Language:eng
Subjects:
Child care
Clinical trials
Cluster analysis
Corticosteroids
Data collection
Delivery rooms
Evaluation
Evidence
Evidence based medicine
Experimental methods
Experimentation
Hospital administration
Infants
Medical care
Medical practice
Medical Research
Neonatal care
Physicians
Random sampling
Research Methodology
Surfactants
U.S.A
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Summary:This article makes a case for cluster-randomized trials to encourage evidence-based practice in medical care. The case rests on theoretical, empirical, and methodological grounds. To illustrate, we describe two recent studies. The first trial, with participation by 27 tertiary care hospitals, concerned methods to encourage a relatively simple, low-cost therapy for women in premature labor. A significant effect was seen in intervention hospitals on the primary outcome variable: increase in the proportion of eligible patients receiving antenatal corticosteroid therapy. The second trial, with participation by 114 neonatal intensive care units, aimed to close the gap between evidence and practice in the use of early and prophylactic surfactant therapy for premature infants. It achieved one of the largest effects seen in the literature on changing medical care practices. Using the two illustrations, the authors discuss some of the theoretical, methodological, and practical issues when using cluster randomized designs in this field of inquiry.
ISSN:0002-7162
1552-3349