Clustering effectsData from both epochs could be clustered because of similarities between babies within hospitals, countries (for epoch one), and neonatal networks (for epoch two). As only aggregate data were available for epoch one, we cannot fully account for this clustering. To investigate variation from clustering in epoch two, however, we calculated the outcome for each network and presented the median and range of these network specific outcomes. We used partially nested random effects models13 to estimate the change between epochs averaged over all neonatal networks. These models allow for clustering to be present in only part of the data. The model is of the form:where epoch(i)=0 for epoch one and 1 for epoch nike sb dunk high r/r
two, and network(i) is given dummy values for epoch one. The average effect across all clusters is given by . The u’s are the random effects, which are only estimated for epoch two, assumed to be normally distributed with mean 0 and variance u2 estimated from the data. The intercept, , is fixed rather than random as there is no clustering in epoch one. The network average odds ratio (exp ) and 95% confidence intervals are presented, together with the P value testing the null hypothesis that the variance between networks is equal to zero, from the likelihood ratio test. This was performed for all binary outcomes except separation because of transfer as the number of babies per network for this outcome nike sb red and black
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