{
  "abstract": "Objectives To evaluate an innovative approach to recruit 40 hospitals to a cluster randomised controlled trial (RCT) to improve discharge antibiotic prescribing.Design This study describes the design, implementation and impact of a theory-informed recruitment approach for hospitals participating in the Reducing Overuse of Antibiotics at Discharge (ROAD) Home trial.Setting An inperson meeting of a quality improvement collaborative of acute care hospitals in the state of Michigan.Participants Representatives from acute care hospitals that are part of the Michigan Hospital Medicine Safety Consortium.Interventions Small group recruitment sessions that combined deliberative participation and credible messengers to recruit hospitals to participate in a cluster RCT on a single date (1 November 2023).Primary and secondary outcomes The primary outcome was the number of hospitals which agreed to participate in the trial. We also assessed participant feedback, effectiveness of recruitment methods and resources required for implementation of this approach.Results We recruited 51 (74%) of 69 eligible hospitals. Survey participants reported: sessions made clear the purpose of the trial (94%, 64/68) and time commitment required (87%, 59/68); agreed deliberative participation was helpful (82%, 56/68) and were ‘very satisfied’ with the session (82%, 56/68). Investigators largely reported credible messengers were a positive influence, though this varied across sessions. Hospital recruitment was time intensive, taking 179.5 total person hours. The recruitment process involved 3 months of preparation for the sessions and 2 months of follow-up prior to closing recruitment.Conclusions We demonstrated the feasibility and impact of a novel approach to recruit hospitals from an existing collaborative to a cluster RCT using the principles of deliberative participation and credible messengers. While the approach was time-consuming, we achieved success at over-recruiting hospitals in a relatively short period of time. Strategies presented here may assist future trial organisers in implementing hospital-based cluster RCTs.Trial registration number The ROAD Home trial is registered on Clinical.Trials.gov ( NCT06106204).",
  "authors": [
    {
      "affiliations": [
        "Department of Internal Medicine, Division of General Internal Medicine, The University of Utah School of Medicine, Salt Lake City, Utah, USA",
        "Department of Internal Medicine, Division of Hospital Medicine, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA"
      ],
      "name": "Valerie M Vaughn"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Division of Hospital Medicine, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA"
      ],
      "name": "Jennifer Horowitz"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA"
      ],
      "name": "Tejal Gandhi"
    },
    {
      "affiliations": [
        "Department of Pharmacy, Michigan Medical Center Midland, Midland, Michigan, USA"
      ],
      "name": "Robert Allan Neetz"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA"
      ],
      "name": "Lindsay Petty"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Division of Pediatric Infectious Diseases, The University of Utah School of Medicine, Salt Lake City, Utah, USA"
      ],
      "name": "Adam Hersh"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts, USA",
        "Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA"
      ],
      "name": "Peter Lindenauer"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, VA Ann Arbor Healthcare System, Ann Arbor, USA",
        "Department of Internal Medicine, University of Michigan Health System, Ann Arbor, USA"
      ],
      "name": "Steven J Bernstein"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Division of Hospital Medicine, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA"
      ],
      "name": "Scott A Flanders"
    },
    {
      "affiliations": [
        "Division of Hospital Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA"
      ],
      "name": "James D Harrison"
    },
    {
      "affiliations": [
        "Department of Population Health Sciences, Division of Health System Innovation & Research, The University of Utah School of Medicine, Salt Lake City, Utah, USA"
      ],
      "name": "Justin D Smith"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Division of General Internal Medicine, The University of Utah School of Medicine, Salt Lake City, Utah, USA"
      ],
      "name": "Andrea T White"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Division of Epidemiology, The University of Utah School of Medicine, Salt Lake City, Utah, USA"
      ],
      "name": "Julia E Szymczak"
    }
  ],
  "title": "Developing an approach to enhance recruitment for a cluster-randomised implementation trial: leveraging deliberative participation and credible messengers",
  "uid": "856f993f-882f-5a8b-b904-dc7eda3caece"
}