1. Joy, Subhashni D. Singh

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According to this study:


* Hospitals participating in clinical trials are more likely to follow recommended guidelines than those that do not.


* Mortality rates are also lower in these hospitals.



Care given in hospitals that take part in clinical trials was compared with that given in hospitals that don't participate. This study involved 494 of the 557 U.S. hospitals that are part of the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines) initiative. The hospitals collectively treated 174,062 patients with non-ST-segment elevation acute coronary syndrome between January 2001 and June 2006; 4,590 of them (2.6%) were participating in clinical trials. To quantify the quality of care, the authors scored hospitals' adherence to nine guideline- recommended therapies. A composite adherence score was determined for each patient.


Of the 494 hospitals, 71% had at least one patient in a clinical trial during the study period. Larger hospitals that were academic institutions and that offered surgical revascularization procedures were most likely to participate in clinical trials. Hospitals that took part in clinical trials were more likely to offer better care, as demonstrated by increased adherence to the nine therapies. For purposes of analysis, the authors stratified the hospitals into three groups. Hospitals that didn't enroll in any trials (n = 145) had a median adherence score of 76.9%. The middle group, with a median of 1% of patients enrolled in a trial (n = 226) had a median adherence score of 78.3%. The 123 hospitals with a median of 4.9% of patients enrolled in a trial had a median adherence score of 81.1%. These 123 hospitals also had lower mortality rates (3.5%) than those that enrolled fewer (4.4%) or no (5.9%) patients.


The authors concluded that hospitals with more patients enrolled in clinical trials provided better care and had lower mortality rates. The authors suggest that patients may want to use hospitals that take part in clinical trials and that, for the hospital, the benefits of participating in clinical trials probably outweigh the possible disadvantages.




Majumdar SR, et al. Arch Intern Med 2008;168(6):657-62.