COMPARISON OF CRT AND RCT

Comparison of CRT and RCT

Comparison of RCT and CRT

Introduction

Well-designed randomized trials provide the best evidence on the value of interventions to improve the quality of medical care. Although observational studies can yield useful insights on the value of practice patterns, concerns about selection of practices and subjects, unmeasured confounding variables, and concurrent changes in practice patterns and outcomes limit precise measurement of the impact of practice in observational studies.

Most recent work on the methodology of RCTs has been carried out in health care by researchers allied with the Cochrane Collaboration (named after Archie Cochrane, an epidemiologist who argued strongly for the synthesis of research evidence based on RCTs). A sibling network, the Campbell Collaboration, was set up in 2000 to apply the same principles to the analysis of evidence about social interventions. This is named after Donald Campbell, a methodologist, whose 1966 book with Julian Stanley, Experimental and Quasi Experimental Designs for Research, established the principles and procedures for the use of RCTs in social science. Unfortunately, the association of the term “RCT” with medicine leads many social scientists to dismiss this method. Objections to the ethics of RCTs ignore the unethical nature of research designs that cannot properly answer the research question. They also fail to acknowledge the normal practice of uncontrolled experimentation, which ensures that people may be subjected to professional and other interventions with unknown, and possibly harmful, effects. The many thousands of RCTs conducted of social interventions show that this method is practical, even in complex social settings. A well-conducted RCT is a powerful method for assessing strategies for solving some of today's most pressing social problems.

This paper discusses why CRT are good or bad than RCTs.

Discussion

A key issue in the design of trials to evaluate quality improvement interventions is the unit of randomization. This can be the individual patient, the provider, a group of providers within a practice, or several practices perhaps within a geographic area. If possible, randomization of individual patients has some key advantages because it allows for evaluation of treatment effects within practices. Randomization of individual patients also reduces the likelihood of covariate imbalances that can arise when practices see different types of patients. Furthermore, a trial that randomizes individual patients can use blocking within practices to limit the threat to validity that arises when practices have different levels of adherence to a protocol or when rates of outcomes vary across practices because providers' clinical skills differ.

A trial that randomizes individual patients can also increase treatment effects, although at some loss of generalizability, through restriction to patients with documented eligibility and interest in the topic of the intervention.

In some situations, randomizing individual patients is either infeasible or unethical. If interventions are directed toward providers, they may find it impossible to deliver different, randomly assigned interventions to their different patients.

If education or evidence leads providers to conclude that therapeutic approach is preferred over others, they cannot ethically deliver an alternative. Furthermore, if patients share information with others treated by ...