RAFF-3 Trial: A Stepped-Wedge Cluster Randomized Trial to Improve Care of Acute Atrial Fibrillation and Flutter in the Emergency Department

2021 ◽  
Author(s):  
Ian G. Stiell ◽  
Patrick M. Archambault ◽  
Judy Morris ◽  
Eric Mercier ◽  
Debra Eagles ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Stepped Wedge ◽  
Cluster Randomized ◽  
Atrial Fibrillation And Flutter

scholarly journals Early and comprehensive care bundle in the elderly for acute heart failure in the emergency department: study protocol of the ELISABETH stepped-wedge cluster randomized trial

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Yonathan Freund ◽  
Judith Gorlicki ◽  
Marine Cachanado ◽  
Sarah Salhi ◽  
Vanessa Lemaître ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Randomized Trial ◽  
Acute Heart Failure ◽  
Study Protocol ◽  
Cluster Randomized Trial ◽  
The Elderly ◽  
Care Bundle ◽  
Stepped Wedge ◽  
Cluster Randomized

scholarly journals LO04: Decreasing emergency department length of stay for patients with acute atrial fibrillation and flutter: a cluster-randomized trial

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S7-S8
Author(s):  
I. Stiell ◽  
D. Eagles ◽  
J. Perry ◽  
P. Archambault ◽  
V. Thiruganasambandamoorthy ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Length Of Stay ◽  
Best Practices ◽  
Sinus Rhythm ◽  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Audit And Feedback ◽  
Stepped Wedge ◽  
Cluster Randomized ◽  
The Impact

Introduction: CAEP recently developed the acute atrial fibrillation (AF) and flutter (AFL) [AAFF] Best Practices Checklist to promote optimal care and guidance on cardioversion and rapid discharge of patients with AAFF. We sought to assess the impact of implementing the Checklist into large Canadian EDs. Methods: We conducted a pragmatic stepped-wedge cluster randomized trial in 11 large Canadian ED sites in five provinces, over 14 months. All hospitals started in the control period (usual care), and then crossed over to the intervention period in random sequence, one hospital per month. We enrolled consecutive, stable patients presenting with AAFF, where symptoms required ED management. Our intervention was informed by qualitative stakeholder interviews to identify perceived barriers and enablers for rapid discharge of AAFF patients. The many interventions included local champions, presentation of the Checklist to physicians in group sessions, an online training module, a smartphone app, and targeted audit and feedback. The primary outcome was length of stay in ED in minutes from time of arrival to time of disposition, and this was analyzed at the individual patient-level using linear mixed effects regression accounting for the stepped-wedge design. We estimated a sample size of 800 patients. Results: We enrolled 844 patients with none lost to follow-up. Those in the control (N = 316) and intervention periods (N = 528) were similar for all characteristics including mean age (61.2 vs 64.2 yrs), duration of AAFF (8.1 vs 7.7 hrs), AF (88.6% vs 82.9%), AFL (11.4% vs 17.1%), and mean initial heart rate (119.6 vs 119.9 bpm). Median lengths of stay for the control and intervention periods respectively were 413.0 vs. 354.0 minutes (P < 0.001). Comparing control to intervention, there was an increase in: use of antiarrhythmic drugs (37.4% vs 47.4%; P < 0.01), electrical cardioversion (45.1% vs 56.8%; P < 0.01), and discharge in sinus rhythm (75.3% vs. 86.7%; P < 0.001). There was a decrease in ED consultations to cardiology and medicine (49.7% vs 41.1%; P < 0.01), but a small but insignificant increase in anticoagulant prescriptions (39.6% vs 46.5%; P = 0.21). Conclusion: This multicenter implementation of the CAEP Best Practices Checklist led to a significant decrease in ED length of stay along with more ED cardioversions, fewer ED consultations, and more discharges in sinus rhythm. Widespread and rigorous adoption of the CAEP Checklist should lead to improved care of AAFF patients in all Canadian EDs.

Digital Adherence Technology for Tuberculosis Treatment Supervision: A Stepped-Wedge Cluster Randomized Trial

2020 ◽  
Author(s):  
Adithya Cattamanchi ◽  
Rebecca R. Crowder ◽  
Alex Kityamuwesi ◽  
Noah Kiwanuka ◽  
Maureen Lamunu ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Tuberculosis Treatment ◽  
Stepped Wedge ◽  
Cluster Randomized

On the centrosymmetry of treatment effect estimators for stepped wedge and related cluster randomized trial designs

2021 ◽  
Vol 172 ◽  
pp. 109022
Author(s):  
Rhys Bowden ◽  
Andrew B. Forbes ◽  
Jessica Kasza
Keyword(s):  
Randomized Trial ◽  
Treatment Effect ◽  
Cluster Randomized Trial ◽  
Stepped Wedge ◽  
Cluster Randomized

scholarly journals Spread and scale of an electronic deprescribing software to improve health outcomes of older adults living in nursing homes: study protocol for a stepped wedge cluster randomized trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Marc-Eric Nadeau ◽  
Justine L. Henry ◽  
Todd C. Lee ◽  
Émilie Bortolussi-Courval ◽  
Carole Goodine ◽  
...  
Keyword(s):  
Older Adults ◽  
Randomized Trial ◽  
Study Design ◽  
Long Term Care ◽  
Cluster Randomized Trial ◽  
Stepped Wedge ◽  
Term Care ◽  
Medication Reviews ◽  
Cluster Randomized

Abstract Background Medication overload or problematic polypharmacy is a major problem causing widespread harm, particularly to older adults. Taking multiple medications increases the risk of potentially inappropriate medications (PIMs), and residents in long-term care (LTC) are frequently prescribed 10 or more medications at once. One strategy to address this problem is for the physician and/or pharmacist to perform regular medication reviews; however, this process can be complicated and time-consuming. With a prescription review, medications may be decreased, changed, or stopped altogether. MedReviewRx is a software that runs an analysis using deprescribing rules to produce a report to guide medication reviews addressing medication overload for residents in LTC. Methods This study will employ a mixed methods effectiveness-implementation hybrid type 2 study design. To measure effectiveness, a stepped wedge cluster randomized trial design is planned, which allows us to approximate a randomized clinical trial. Approximately 1000 residents living in LTC will be recruited from five facilities in New Brunswick. The study will begin with 3 months of baseline data on rates of deprescribing. Thereafter, every 3 months a new cluster will enter the intervention mode. The intervention consists of medication reviews augmented with the MedReviewRx software, which will be used by staff and clinicians in the facilities. The estimated study duration is 18 months and the main outcome will be the proportion of patients with one or more PIMs deprescribed (reduced/stopped or changed to a safer alternative) in the 90 days following a prescription review. The goal is to study the impact of MedReviewRx on medication overload among older adults living in LTC. In typical fashion of a stepped wedge cluster randomized trial, each cluster acts as an internal control (before and after) as well as a control for the other clusters (external control). Qualitative data collected will include resident/caregiver attitudes towards deprescribing and semi-structured interviews with staff working in the long-term care homes. Discussion This study design addresses issues with seasonality and allows all clusters to participate in the intervention, which is an advantage when the intervention is related to quality improvement. This study will provide valuable information on PIM use, cost savings, and facilitators and challenges associated with medication reviews and deprescribing. This study represents an important step towards understanding and promoting tools to guide safe and rational reduction of PIM use among older adults. Trial registration NCT04762303, Registered February 21, 2021.

Variance formulae for multiphase stepped wedge cluster randomized trial

2020 ◽  
Vol 39 (28) ◽  
pp. 4147-4168 ◽  
Author(s):  
Pengyue Zhang ◽  
Abigail Shoben ◽  
Rebecca Jackson ◽  
Soledad Fernandez
Keyword(s):  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Stepped Wedge ◽  
Cluster Randomized
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