Abstract
Hospitals often have rotational assignment of patients to one of several similar provider care teams. The research potential of these arrangements has gone unnoticed. By changing to random assignment of patients and physicians to provider care teams (firms) this kind of organization can be used for sequential, randomized clinical trials which are ethical and efficient. The paper describes such arrangements at three different hospitals: Cleveland Metropolitan General Hospital, Brooke Army Medical Center, and University Hospitals of Cleveland. Associated methodologic issues are discussed. This is a new, more widely applicable method for medical care research.
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- Boruch R. F., Mcsweeny A. J., Soderstrom E. J. Randomized field experiments for program planning, development, and evaluation: an illustrative bibliography. Eval Q. 1978 Nov;2(4):655–695. doi: 10.1177/0193841x7800200411. [DOI] [PubMed] [Google Scholar]
- CHALMERS T. C., ECKHARDT R. D., REYNOLDS W. E., CIGARROA J. G., Jr, DEANE N., REIFENSTEIN R. W., SMITH C. W., DAVIDSON C. S. The treatment of acute infectious hepatitis. Controlled studies of the effects of diet, rest, and physical reconditioning on the acute course of the disease and on the incidence of relapses and residual abnormalities. J Clin Invest. 1955 Jul;34(7 Pt 2):1163–1235. doi: 10.1172/JCI103164. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cohen D. I., Jones P., Littenberg B., Neuhauser D. Does cost information availability reduce physician test usage? A randomized clinical trial with unexpected findings. Med Care. 1982 Mar;20(3):286–292. doi: 10.1097/00005650-198203000-00005. [DOI] [PubMed] [Google Scholar]
- Cohen D. I., Littenberg B., Wetzel C., Neuhauser D. Improving physician compliance with preventive medicine guidelines. Med Care. 1982 Oct;20(10):1040–1045. doi: 10.1097/00005650-198210000-00006. [DOI] [PubMed] [Google Scholar]
- Halperin W., Neuhauser D. MEU: measuring efficient utilization of hospital services. Health Care Manage Rev. 1976 Spring;1(2):63–70. doi: 10.1097/00004010-197600120-00009. [DOI] [PubMed] [Google Scholar]
- Hershey C. O., Porter D. K., Breslau D., Cohen D. I. Influence of simple computerized feedback on prescription charges in an ambulatory clinic. A randomized clinical trial. Med Care. 1986 Jun;24(6):472–481. doi: 10.1097/00005650-198606000-00002. [DOI] [PubMed] [Google Scholar]
- Hershey C. O., Tomford J. W., McLaren C. E., Porter D. K., Cohen D. I. The natural history of intravenous catheter-associated phlebitis. Arch Intern Med. 1984 Jul;144(7):1373–1375. [PubMed] [Google Scholar]
- Martin A. R., Wolf M. A., Thibodeau L. A., Dzau V., Braunwald E. A trial of two strategies to modify the test-ordering behavior of medical residents. N Engl J Med. 1980 Dec 4;303(23):1330–1336. doi: 10.1056/NEJM198012043032304. [DOI] [PubMed] [Google Scholar]
- Tomford J. W., Hershey C. O., McLaren C. E., Porter D. K., Cohen D. I. Intravenous therapy team and peripheral venous catheter-associated complications. A prospective controlled study. Arch Intern Med. 1984 Jun;144(6):1191–1194. [PubMed] [Google Scholar]
- Waggoner D. M., Frengley J. D., Griggs R. C., Rammelkamp C. H. A 'firm' system for graduate training in general internal medicine. J Med Educ. 1979 Jul;54(7):556–561. doi: 10.1097/00001888-197907000-00006. [DOI] [PubMed] [Google Scholar]
- Whiting-O'Keefe Q. E., Henke C., Simborg D. W. Choosing the correct unit of analysis in Medical Care experiments. Med Care. 1984 Dec;22(12):1101–1114. doi: 10.1097/00005650-198412000-00005. [DOI] [PubMed] [Google Scholar]