title: Creating the right evidence for system change.
abstract: Most evaluative research is focused on assessing new technologies at the patient level. Comparatively little is focused on assessing how system changes could improve the delivery of healthcare. In this article, the authors describe an opportunity to conduct evaluative trials of system changes affordably and efficiently by using a cluster randomized design and mandatory reporting data, using the prevention of Clostridium difficile infection as an example. They then describe what must be done to make similar trials a regular tool of healthcare policy.
authors.affiliation: Kenneth Lam, BSc, is a Keenan research summer student at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, in Toronto, Ontario; and a medical student at Western University, in London, Ontario.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Lam
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Hwang
authors.forename: Irfan A
authors.initials: IA
authors.lastname: Dhalla
authors.forename: Susy
authors.initials: S
authors.lastname: Hota
authors.forename: Kevin
authors.initials: K
authors.lastname: Thorpe
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Palda
authors.forename: Adalsteinn
authors.initials: A
authors.lastname: Brown
authors.forename: David J
authors.initials: DJ
authors.lastname: Klein
mesh_terms: D002170:Canada; D016360:Clostridioides difficile / Q000302:isolation & purification; D016000:Cluster Analysis; D004761:Enterocolitis, Pseudomembranous / Q000517:prevention & control; D019317:Evidence-Based Medicine; D018166:Health Care Reform; D006801:Humans; D019221:Mandatory Reporting; D061214:Patient Safety; D016032:Randomized Controlled Trials as Topic; D012107:Research Design