Baseline hospital performance and the impact of medical emergency teams

modelling vs. conventional subgroup analysis

Jack Chen, Arthas Flabouris, Rinaldo Bellomo, Ken Hillman, Simon Finfer, MERIT Study Investigators for the Simpson Centre, The ANZICS Clinical Trials Group

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: To compare two approaches to the statistical analysis of the relationship between the baseline incidence of adverse events and the effect of medical emergency teams (METs). 

Methods: Using data from a cluster randomized controlled trial (the MERIT study), we analysed the relationship between the baseline incidence of adverse events and its change from baseline to the MET activation phase using quadratic modelling techniques. We compared the findings with those obtained with conventional subgroup analysis. 

Results: Using linear and quadratic modelling techniques, we found that each unit increase in the baseline incidence of adverse events in MET hospitals was associated with a 0.59 unit subsequent reduction in adverse events (95%CI: 0.33 to 0.86) after MET implementation and activation. This applied to cardiac arrests (0.74; 95%CI: 0.52 to 0.95), unplanned ICU admissions (0.56; 95%CI: 0.26 to 0.85) and unexpected deaths (0.68; 95%CI: 0.45 to 0.90). Control hospitals showed a similar reduction only for cardiac arrests (0.95; 95%CI: 0.56 to 1.32). Comparison using conventional subgroup analysis, on the other hand, detected no significant difference between MET and control hospitals. 

Conclusions: Our study showed that, in the MERIT study, when there was dependence of treatment effect on baseline performance, an approach based on regression modelling helped illustrate the nature and magnitude of such dependence while sub-group analysis did not. The ability to assess the nature and magnitude of such dependence may have policy implications. Regression technique may thus prove useful in analysing data when there is a conditional treatment effect.

Original languageEnglish
Article number117
Pages (from-to)1-11
Number of pages11
JournalTrials
Volume10
DOIs
Publication statusPublished - 19 Dec 2009
Externally publishedYes

Keywords

  • Cardiopulmonary Resuscitation/adverse effects
  • Emergency Service, Hospital/statistics & numerical data
  • Heart Arrest/mortality
  • Hospital Mortality
  • Humans
  • Incidence
  • Intensive Care Units/statistics & numerical data
  • Linear Models
  • Models, Statistical
  • Outcome Assessment (Health Care)/statistics & numerical data

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  • Cite this

    Chen, J., Flabouris, A., Bellomo, R., Hillman, K., Finfer, S., MERIT Study Investigators for the Simpson Centre, & The ANZICS Clinical Trials Group (2009). Baseline hospital performance and the impact of medical emergency teams: modelling vs. conventional subgroup analysis. Trials, 10, 1-11. [117]. https://doi.org/10.1186/1745-6215-10-117