Adjusting for bias in randomized cluster trials

The randomized cluster design is typical in studies where the unit of randomization is a cluster of individuals rather than the individual. Evaluating various intervention strategies across medical care providers at either an institutional level or at a physician group practice level fits the randomized cluster model. Clearly, the analytical approach to such studies must take the unit of randomization and accompanying intraclass correlation into consideration. We review alternative methods to the typical Pearson's chi-square analysis and illustrate these alternatives. We have written and tested a Fortran program that produces the statistics outlined in this paper. The program, in an executable format is available from the author on request.