Adherence outcome power
For power estimation, we simulated intervention data using observed adherence proportions at each center during the baseline period, assuming fourfold improvement from baseline in relative adherence odds in the control arm in years 2–4, with higher improvement in the TEACH arm.Study adherence data will exhibit clustering at the patient and hospital level and possibly by calendar day. We used a partially heuristic approach to power estimation, incorporating the variance inflation factor for clustered studies. Considering the intraclass correlation observed in the baseline study data and the distributions of eligible ICU days per study patient, a heuristic, conservative derivation yields a variance inflation factor of approximately 4.5 for adherence data [