It is common for treatments to be evaluated in clinical trials that involve many sites or centers, primarily because one center rarely can enroll sufficient numbers of patients to complete the trial.1 The use of multiple clinical sites introduces complexity because outcomes at different sites may be systematically different, eg, due to differences in patient populations, ancillary treatment practices, or other factors. Thus, appropriate statistical analyses of multicenter clinical trials consider these center effects to yield a better understanding of the overall mean treatment effect and the variability in treatment effects and patient outcomes among sites.1
Senn SJ, Lewis RJ. Treatment Effects in Multicenter Randomized Clinical Trials. JAMA. Published online March 01, 2019321(12):1211–1212. doi:10.1001/jama.2019.1480
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