Format

Send to

Choose Destination
See comment in PubMed Commons below
Health Serv Res. 2017 Aug 21. doi: 10.1111/1475-6773.12752. [Epub ahead of print]

Estimation of Population Average Treatment Effects in the FIRST Trial: Application of a Propensity Score-Based Stratification Approach.

Author information

1
Department of Surgery, Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, IL.
2
Department of Statistics, Department of Psychology, Department of Medical Social Sciences, School of Education and Social Policy, Institute for Policy Research, Northwestern University, Evanston, IL.

Abstract

OBJECTIVE/STUDY QUESTION:

To estimate and compare sample average treatment effects (SATE) and population average treatment effects (PATE) of a resident duty hour policy change on patient and resident outcomes using data from the Flexibility in Duty Hour Requirements for Surgical Trainees Trial ("FIRST Trial").

DATA SOURCES/STUDY SETTING:

Secondary data from the National Surgical Quality Improvement Program and the FIRST Trial (2014-2015).

STUDY DESIGN:

The FIRST Trial was a cluster-randomized pragmatic noninferiority trial designed to evaluate the effects of a resident work hour policy change to permit greater flexibility in scheduling on patient and resident outcomes. We estimated hierarchical logistic regression models to estimate the SATE of a policy change on outcomes within an intent-to-treat framework. Propensity score-based poststratification was used to estimate PATE.

DATA COLLECTION/EXTRACTION METHODS:

This study was a secondary analysis of previously collected data.

PRINCIPAL FINDINGS:

Although SATE estimates suggested noninferiority of outcomes under flexible duty hour policy versus standard policy, the noninferiority of a policy change was inconclusively noninferior based on PATE estimates due to imprecision.

CONCLUSIONS:

Propensity score-based poststratification can be valuable tools to address trial generalizability but may yield imprecise estimates of PATE when sparse strata exist.

KEYWORDS:

Resident duty hours; generalizability; medical education; propensity score methods; surgical outcomes

PMID:
28833067
DOI:
10.1111/1475-6773.12752
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Wiley
    Loading ...
    Support Center