Step Wedge Cluster Design for Service Delivery Interventions Comes to New England Journal of Medicine

Dreischulte and colleagues randomised 34 practices in clusters using a step-wedge design, to evaluate a complex intervention to reduce prescription errors in primary care.[1] The intervention included an educational component and informatics (as in the famous PINCER trial [2]), but also included a financial incentive. There was a marked drop in the types of high-risk prescribing targeted in the intervention. In addition, admissions decreased in the hypothesised direction. Adjustments were made for intra-class correlations at various time points, but what about temporal trends? Is this the first step wedge cluster study in the world’s top medical journal?

— Richard Lilford, CLAHRC WM Director


  1. Dreischulte T, Donnan P, Grant A, et al. Safer Prescribing – A Trial of Education, Informatics, and Financial Incentives. New Engl J Med. 2016; 374(11): 1053-64.
  2. Hemming K, Chilton PJ, Lilford RJ, Avery A, Sheikh A. Bayesian cohort and cross-sectional analyses of the PINCER trial: a pharmacist-led intervention to reduce medication errors in primary care. PLoS One. 2012; 7(6): e38306.

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