Analysis of multisite intervention studies using generalized linear mixed models.

Multisite intervention studies have become increasingly common in infection control, for example, looking for a change in hospital infection rates after a regional policy change. The design of these studies can take various forms, from pre-post observational studies to randomized trials, in which sites are randomly assigned to the intervention or in which the intervention is sequentially introduced to different sites over time. Data collected under these settings are clustered by hospital and/or ward, consist of repeated measurements and, in some cases, exhibit temporal and/or seasonal patterns. Failure to account for these features in data analysis could well result in biased estimates of intervention effectiveness and impact on the generalizability of model results.