Academic and Community ICUs Participating in a Critical Care Randomized Trial: A Comparison of Patient Characteristics and Trial Metrics

Jennifer L. Y. Tsang, MD, PhD; Alexandra Binnie, MD, DPhil; Erick H. Duan, MD, MSc; Jennie Johnstone, MD, PhD; Diane Heels-Ansdell, MSc; Brenda Reeve, MD; Sebastien Trop, MD, PhD; Paul Hosek, MD; Joanna C. Dionne, MD, PhD; Patrick Archambault, MD, MSc; Paul Lysecki, MD; Robert Cirone, MD; Nicole L. Zytaruk, RN; William Dechert, MSc; Mercedes Peñuela Camargo, MSc; Rebecca Jesso, MN, NP; Elliot McMillan, RN, PhD; Zaynab Panchbhaya, MSN; Tracy Campbell, MSc; Lois Saunders; Mary Copland, BA; Kanthi Kavikondala, BSc; Deborah J. Cook, MD, MSc; for the Probiotics: Prevention of Severe Pneumonia and Endotracheal Colonization Trial (PROSPECT) Investigators and the Canadian Critical Care Trials Group

doi:10.1097/CCE.0000000000000794

Critical Care Explorations (Nov 2022)

Academic and Community ICUs Participating in a Critical Care Randomized Trial: A Comparison of Patient Characteristics and Trial Metrics

Jennifer L. Y. Tsang, MD, PhD,
Alexandra Binnie, MD, DPhil,
Erick H. Duan, MD, MSc,
Jennie Johnstone, MD, PhD,
Diane Heels-Ansdell, MSc,
Brenda Reeve, MD,
Sebastien Trop, MD, PhD,
Paul Hosek, MD,
Joanna C. Dionne, MD, PhD,
Patrick Archambault, MD, MSc,
Paul Lysecki, MD,
Robert Cirone, MD,
Nicole L. Zytaruk, RN,
William Dechert, MSc,
Mercedes Peñuela Camargo, MSc,
Rebecca Jesso, MN, NP,
Elliot McMillan, RN, PhD,
Zaynab Panchbhaya, MSN,
Tracy Campbell, MSc,
Lois Saunders,
Mary Copland, BA,
Kanthi Kavikondala, BSc,
Deborah J. Cook, MD, MSc,
for the Probiotics: Prevention of Severe Pneumonia and Endotracheal Colonization Trial (PROSPECT) Investigators and the Canadian Critical Care Trials Group

Affiliations

Jennifer L. Y. Tsang, MD, PhD: 1 Division of Critical Care, Department of Medicine, Niagara Health, St. Catharines, ON, Canada.
Alexandra Binnie, MD, DPhil: 3 Department of Critical Care, William Osler Health System, Brampton, ON, Canada.
Erick H. Duan, MD, MSc: 1 Division of Critical Care, Department of Medicine, Niagara Health, St. Catharines, ON, Canada.
Jennie Johnstone, MD, PhD: 6 Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
Diane Heels-Ansdell, MSc: 8 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Brenda Reeve, MD: 9 Division of Critical Care, Brantford General Hospital, Brantford, ON, Canada.
Sebastien Trop, MD, PhD: 3 Department of Critical Care, William Osler Health System, Brampton, ON, Canada.
Paul Hosek, MD: 10 Division of Critical Care, Grand River Hospital, Kitchener, ON, Canada.
Joanna C. Dionne, MD, PhD: 2 Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada.
Patrick Archambault, MD, MSc: 12 Department of Emergency Medicine, Hôtel-Dieu de Lévis, Lévis, QC, Canada.
Paul Lysecki, MD: 13 Department of Medicine, Joseph Brant Hospital, Burlington, ON, Canada.
Robert Cirone, MD: 14 Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Nicole L. Zytaruk, RN: 5 Department of Medicine, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada.
William Dechert, MSc: 9 Division of Critical Care, Brantford General Hospital, Brantford, ON, Canada.
Mercedes Peñuela Camargo, MSc: 1 Division of Critical Care, Department of Medicine, Niagara Health, St. Catharines, ON, Canada.
Rebecca Jesso, MN, NP: 10 Division of Critical Care, Grand River Hospital, Kitchener, ON, Canada.
Elliot McMillan, RN, PhD: 10 Division of Critical Care, Grand River Hospital, Kitchener, ON, Canada.
Zaynab Panchbhaya, MSN: 3 Department of Critical Care, William Osler Health System, Brampton, ON, Canada.
Tracy Campbell, MSc: 13 Department of Medicine, Joseph Brant Hospital, Burlington, ON, Canada.
Lois Saunders: 5 Department of Medicine, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada.
Mary Copland, BA: 5 Department of Medicine, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada.
Kanthi Kavikondala, BSc: 14 Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Deborah J. Cook, MD, MSc: 2 Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada.
for the Probiotics: Prevention of Severe Pneumonia and Endotracheal Colonization Trial (PROSPECT) Investigators and the Canadian Critical Care Trials Group

DOI: https://doi.org/10.1097/CCE.0000000000000794
Journal volume & issue: Vol. 4, no. 11
p. e0794

Abstract

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OBJECTIVES:. Clinical research in Canada is conducted primarily in “academic” hospitals, whereas most clinical care is provided in “community” hospitals. The objective of this nested observational study was to compare patient characteristics, outcomes, process-of-care variables, and trial metrics for patients enrolled in a large randomized controlled trial who were admitted to academic and community hospitals in Canada. DESIGN:. We conducted a preplanned observational study nested within the Probiotics: Prevention of Severe Pneumonia and Endotracheal Colonization Trial (PROSPECT, a randomized controlled trial comparing probiotics to placebo in mechanically ventilated patients) Research Program. SETTING:. ICUs. PATIENTS:. Mechanically ventilated patients. MEASUREMENTS:. We compared patient characteristics, interventions, outcomes, and trial metrics between patients enrolled in PROSPECT from academic and community hospitals. MAIN RESULTS:. Participating centers included 34 (82.9%) academic and seven (17.1%) community hospitals, which enrolled 2,203 (86.2%) and 352 (13.8%) patients, respectively. Compared with academic hospitals, patients enrolled in community hospitals were older (mean [sd] 62.7 yr [14.9 yr] vs 59.5 yr [16.4 yr]; p = 0.044), had longer ICU stays (median [interquartile range {IQR}], 13 d [8–23 d] vs 11 d [7–8 d]; p = 0.012) and higher mortality (percentage, [95% CI] in the ICU, 30.4% [25.8–35.4%]vs 20.5% [18.9–11.3%]; p = 0.002) and hospital (40.6% [35.6–45.8%] vs 26.1% [24.3–27.9%]; p < 0.001). Trial metrics, including informed consent rate (85.9% vs 76.3%; p = 0.149), mean (sd) monthly enrolment rate (2.1 [1.4] vs 1.1 [0.7]; p = 0.119), and protocol adherence (90.6% vs 91.6%; p = 0.207), were similar between community and academic ICUs. CONCLUSIONS:. Community hospitals can conduct high-quality research, with similar trial metrics to academic hospitals. Patient characteristics differed between community and academic hospitals, highlighting the need for broader engagement of community hospitals in clinical research to ensure generalizability of study results.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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