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Sampling Patients Within and Across Health Care Providers: Multi-Stage Non-Nested Samples in Health Services Research

John L. AdamsContact Information, Matthias SchonlauContact Information, José J. EscarceContact Information, Meredith KilgoreContact Information, Michael SchoenbaumContact Information and Dana P. GoldmanContact Information

(1) RAND, 1700 Main Street, Santa Monica, CA, 90401
(2) University of Alabama, School of Public Health, RPHB 330, 1530 3rd Ave S., Birmingham, AL, 35294

Abstract  In order to better inform study design decisions when sampling patients within and across health care providers we develop a simulation-based approach for designing complex multi-stage samples. The approach explores the tradeoff between competing design goals such as precision of estimates, coverage of the target population and cost.
We elicit a number of sensible candidate designs, evaluate these designs with respect to multiple sampling goals, investigate their tradeoffs, and identify the design that is the best compromise among all goals. This approach recognizes that, in the practice of sampling, precision of the estimates is not the only important goal, and that there are tradeoffs with coverage and cost that should be explicitly considered. One can easily add other goals. We construct a sample frame with all phase III clinical cancer treatment trials that are conducted by cooperative oncology groups of the National Cancer Institute from October 1, 1998 through December 31, 1999. Simulation results for our study suggest sampling a different number of trials and institutions than initially considered.
Simulations of different study designs can uncover efficiency gains both in terms of improved precision of the estimates and in terms of improved coverage of the target population. Simulations enable us to explore the tradeoffs between competing sampling goals and to quantify these efficiency gains. This is true even for complex designs where the stages are not strictly nested in one another.

clinical trials - sampling bias - sampling studies - simulation


Contact InformationJohn L. Adams
Email: john_adams@rand.org

Contact InformationMatthias Schonlau
Email: matthias_schonlau@rand.org

Contact InformationJosé J. Escarce
Email: jose_escarce@rand.org

Contact InformationMeredith Kilgore
Email: mkilgore@ms.soph.uab.edu

Contact InformationMichael Schoenbaum
Email: michael_schoenbaum@rand.org

Contact InformationDana P. Goldman
Email: dana_goldman@rand.org
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